| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
18,980 |
17,889 |
$3.67M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,190 |
16,897 |
$2.64M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13,296 |
12,654 |
$1.71M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
8,658 |
8,288 |
$1.55M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
6,755 |
6,449 |
$1.22M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
4,163 |
4,048 |
$821K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
2,718 |
2,502 |
$589K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
2,496 |
2,459 |
$580K |
| 80053 |
Comprehensive metabolic panel |
16,320 |
15,292 |
$471K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
7,892 |
2,830 |
$436K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
9,232 |
8,850 |
$426K |
| 70450 |
Computed tomography, head or brain; without contrast material |
1,615 |
1,597 |
$424K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
3,622 |
3,551 |
$411K |
| 81025 |
|
6,545 |
6,278 |
$379K |
| 99215 |
Prolong outpt/office vis |
2,774 |
2,706 |
$362K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,204 |
2,203 |
$317K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,120 |
1,102 |
$277K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,956 |
1,955 |
$261K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,743 |
1,660 |
$254K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
3,128 |
3,024 |
$241K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,799 |
1,789 |
$232K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
894 |
891 |
$227K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,456 |
1,452 |
$190K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,279 |
1,279 |
$173K |
| 36415 |
Collection of venous blood by venipuncture |
3,853 |
2,639 |
$161K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,034 |
1,027 |
$161K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,565 |
2,455 |
$131K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
1,076 |
1,004 |
$124K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
3,634 |
3,408 |
$114K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,148 |
2,147 |
$110K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
677 |
650 |
$110K |
| 97161 |
|
1,329 |
1,320 |
$108K |
| 90686 |
|
4,128 |
4,119 |
$107K |
| Q3014 |
Telehealth originating site facility fee |
1,911 |
1,786 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,418 |
1,246 |
$92K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
3,081 |
3,073 |
$92K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
351 |
347 |
$90K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
4,482 |
4,113 |
$84K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
704 |
701 |
$83K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
4,978 |
4,698 |
$78K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
2,941 |
2,143 |
$77K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
1,226 |
1,226 |
$64K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
805 |
420 |
$62K |
| 80051 |
|
1,397 |
1,358 |
$55K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,559 |
2,451 |
$55K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
356 |
345 |
$55K |
| 80061 |
Lipid panel |
5,440 |
5,421 |
$52K |
| 84443 |
Thyroid stimulating hormone (TSH) |
8,113 |
7,995 |
$52K |
| 86850 |
|
1,216 |
1,182 |
$50K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
1,447 |
1,446 |
$45K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
999 |
885 |
$45K |
| D1110 |
Prophylaxis - adult |
752 |
674 |
$44K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
181 |
180 |
$44K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
885 |
264 |
$43K |
| 76830 |
Ultrasound, transvaginal |
1,123 |
1,119 |
$40K |
| D9997 |
|
842 |
284 |
$40K |
| 90715 |
|
1,599 |
1,595 |
$39K |
| 90651 |
|
505 |
504 |
$38K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
154 |
153 |
$38K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
687 |
326 |
$38K |
| 12001 |
|
95 |
95 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
223 |
126 |
$34K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
5,040 |
3,594 |
$33K |
| A9585 |
Injection, gadobutrol, 0.1 ml |
873 |
467 |
$30K |
| 71046 |
Radiologic examination, chest; 2 views |
3,444 |
3,399 |
$30K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,760 |
4,661 |
$30K |
| 90670 |
|
1,229 |
1,228 |
$29K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
18,045 |
16,440 |
$26K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
15 |
13 |
$25K |
| 87634 |
|
883 |
865 |
$25K |
| 86900 |
|
1,390 |
1,350 |
$25K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
3,964 |
3,949 |
$24K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
694 |
669 |
$23K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
647 |
644 |
$23K |
| 83880 |
|
898 |
838 |
$23K |
| 90677 |
|
408 |
408 |
$21K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
2,150 |
2,149 |
$20K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
77 |
77 |
$20K |
| G0008 |
Administration of influenza virus vaccine |
1,038 |
1,036 |
$19K |
| 82607 |
|
1,801 |
1,790 |
$19K |
| 91322 |
|
241 |
240 |
$18K |
| 71045 |
Radiologic examination, chest; single view |
2,419 |
2,344 |
$18K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
3,316 |
3,077 |
$18K |
| 90680 |
|
933 |
933 |
$18K |
| 90648 |
|
918 |
918 |
$18K |
| 86901 |
|
1,266 |
1,230 |
$17K |
| G0444 |
Annual depression screening, 5 to 15 minutes |
405 |
403 |
$15K |
| 71271 |
|
230 |
230 |
$14K |
| 90633 |
|
645 |
645 |
$14K |
| 83655 |
|
1,142 |
1,116 |
$14K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
364 |
359 |
$13K |
| 92552 |
|
139 |
139 |
$13K |
| 71250 |
|
137 |
137 |
$13K |
| 96160 |
|
285 |
285 |
$12K |
| 90723 |
|
688 |
688 |
$12K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
155 |
155 |
$12K |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
108 |
106 |
$12K |
| 90732 |
|
162 |
162 |
$12K |
| 84439 |
|
1,799 |
1,778 |
$11K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,289 |
1,285 |
$11K |
| D9310 |
|
158 |
137 |
$11K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
2,736 |
1,661 |
$11K |
| 84403 |
|
681 |
679 |
$10K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
5,827 |
5,132 |
$10K |
| 92551 |
|
183 |
183 |
$9K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
235 |
130 |
$9K |
| 82728 |
|
1,014 |
1,002 |
$9K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
420 |
412 |
$9K |
| 90700 |
|
410 |
409 |
$9K |
| 73564 |
|
1,020 |
1,005 |
$9K |
| D1206 |
Topical application of fluoride varnish |
294 |
294 |
$8K |
| 86618 |
|
1,020 |
1,012 |
$8K |
| 29125 |
|
28 |
28 |
$8K |
| 85610 |
|
2,312 |
2,073 |
$8K |
| 87481 |
|
232 |
231 |
$8K |
| 85027 |
|
3,191 |
3,011 |
$8K |
| 76801 |
|
161 |
159 |
$8K |
| 82565 |
|
1,822 |
1,745 |
$7K |
| 59025 |
Fetal non-stress test |
41 |
24 |
$7K |
| 90734 |
|
319 |
319 |
$7K |
| D1120 |
Prophylaxis - child |
157 |
157 |
$7K |
| 90656 |
|
348 |
348 |
$7K |
| 83735 |
|
5,048 |
4,530 |
$7K |
| 90697 |
|
298 |
298 |
$7K |
| 99406 |
|
329 |
324 |
$7K |
| 86803 |
|
1,134 |
1,131 |
$7K |
| 0001A |
|
188 |
187 |
$7K |
| 76770 |
|
84 |
82 |
$6K |
| 84702 |
|
1,368 |
1,170 |
$6K |
| 86780 |
|
900 |
893 |
$6K |
| 73610 |
|
1,009 |
999 |
$6K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
404 |
278 |
$5K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
37 |
20 |
$5K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
2,964 |
2,871 |
$5K |
| 84466 |
|
630 |
626 |
$5K |
| 76536 |
|
230 |
230 |
$5K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,196 |
2,164 |
$5K |
| 90480 |
|
248 |
247 |
$5K |
| 81513 |
|
228 |
227 |
$5K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
129 |
129 |
$4K |
| 12002 |
|
13 |
12 |
$4K |
| 0002A |
|
124 |
124 |
$4K |
| 0124A |
|
111 |
111 |
$4K |
| 0004A |
|
135 |
135 |
$4K |
| 73630 |
|
937 |
925 |
$4K |
| 94010 |
|
79 |
79 |
$4K |
| 73130 |
|
649 |
633 |
$4K |
| U0005 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 |
177 |
150 |
$4K |
| 82948 |
|
1,293 |
895 |
$4K |
| 99442 |
|
33 |
33 |
$4K |
| 93017 |
|
32 |
32 |
$4K |
| 99443 |
|
31 |
31 |
$3K |
| 80076 |
|
259 |
256 |
$3K |
| 0071A |
|
100 |
100 |
$3K |
| 83540 |
|
908 |
899 |
$3K |
| 86666 |
|
613 |
350 |
$3K |
| 81003 |
|
5,327 |
4,789 |
$3K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
33 |
12 |
$3K |
| 95806 |
|
46 |
46 |
$3K |
| 0072A |
|
85 |
85 |
$3K |
| 0064A |
|
90 |
90 |
$3K |
| 87476 |
|
154 |
154 |
$3K |
| G0378 |
Hospital observation service, per hour |
38 |
25 |
$3K |
| 73030 |
|
475 |
462 |
$3K |
| 81001 |
|
5,570 |
5,288 |
$3K |
| 94060 |
|
12 |
12 |
$3K |
| 82670 |
|
193 |
192 |
$3K |
| 87070 |
|
1,226 |
1,201 |
$2K |
| 84153 |
|
176 |
173 |
$2K |
| 86140 |
|
1,218 |
1,159 |
$2K |
| 83690 |
|
5,119 |
4,850 |
$2K |
| 87653 |
|
37 |
37 |
$2K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
15 |
13 |
$2K |
| 94726 |
|
12 |
12 |
$2K |
| 87468 |
|
71 |
71 |
$2K |
| D0330 |
Panoramic radiographic image |
55 |
51 |
$2K |
| 0134A |
|
60 |
59 |
$2K |
| 82570 |
|
554 |
543 |
$2K |
| 93971 |
|
49 |
49 |
$2K |
| 0011A |
|
72 |
72 |
$2K |
| 84484 |
|
4,236 |
3,552 |
$2K |
| 97113 |
|
60 |
24 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
48 |
46 |
$2K |
| 87077 |
|
1,133 |
1,068 |
$2K |
| 72110 |
|
125 |
125 |
$2K |
| 90710 |
|
90 |
90 |
$2K |
| 84520 |
|
1,567 |
1,500 |
$2K |
| 73110 |
|
388 |
381 |
$2K |
| 84450 |
|
1,783 |
1,718 |
$2K |
| 0012A |
|
53 |
52 |
$2K |
| D1351 |
Sealant - per tooth |
37 |
12 |
$2K |
| 85652 |
|
1,170 |
1,129 |
$1K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
30 |
30 |
$1K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
2,131 |
2,040 |
$1K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
4,694 |
4,206 |
$1K |
| 86762 |
|
246 |
244 |
$1K |
| 82550 |
|
1,718 |
1,630 |
$1K |
| 87186 |
|
891 |
841 |
$1K |
| 87484 |
|
71 |
71 |
$1K |
| 87478 |
|
71 |
71 |
$1K |
| 87469 |
|
71 |
71 |
$1K |
| 80306 |
|
1,955 |
1,781 |
$1K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
554 |
516 |
$1K |
| 87081 |
|
1,510 |
1,491 |
$1K |
| 84480 |
|
249 |
245 |
$1K |
| 82947 |
|
1,207 |
1,182 |
$1K |
| G0009 |
Administration of pneumococcal vaccine |
57 |
57 |
$1K |
| 76642 |
|
52 |
52 |
$1K |
| 82043 |
|
273 |
273 |
$982.02 |
| 58300 |
|
14 |
14 |
$980.86 |
| 85379 |
|
1,196 |
1,170 |
$917.99 |
| 97150 |
Therapeutic procedure(s), group (2 or more individuals) |
60 |
24 |
$861.35 |
| 87340 |
|
271 |
270 |
$846.13 |
| 70486 |
|
12 |
12 |
$802.01 |
| 90707 |
|
26 |
26 |
$797.18 |
| 85730 |
|
1,284 |
1,250 |
$795.20 |
| 82247 |
|
1,629 |
1,522 |
$767.80 |
| 82040 |
|
1,436 |
1,396 |
$690.10 |
| 84402 |
|
44 |
44 |
$635.38 |
| 84146 |
|
57 |
55 |
$627.74 |
| G0145 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
24 |
24 |
$612.85 |
| 87807 |
|
99 |
99 |
$546.75 |
| 74018 |
|
108 |
107 |
$539.22 |
| 90696 |
|
30 |
30 |
$535.50 |
| 77080 |
|
12 |
12 |
$517.86 |
| 83605 |
|
1,364 |
1,197 |
$510.16 |
| 72125 |
Computed tomography, cervical spine; without contrast material |
14 |
14 |
$479.20 |
| 82746 |
|
52 |
52 |
$462.57 |
| 80320 |
|
1,234 |
1,146 |
$461.19 |
| 83550 |
|
110 |
109 |
$446.57 |
| 83520 |
|
45 |
44 |
$437.24 |
| 86753 |
|
117 |
116 |
$415.42 |
| 90620 |
|
25 |
25 |
$410.55 |
| 0081A |
|
14 |
14 |
$397.86 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
13 |
13 |
$362.62 |
| 86617 |
|
48 |
27 |
$356.27 |
| 85018 |
|
816 |
796 |
$335.52 |
| 82950 |
|
107 |
106 |
$332.73 |
| 86592 |
|
188 |
187 |
$304.98 |
| 87040 |
|
795 |
430 |
$301.18 |
| 73502 |
|
37 |
37 |
$296.91 |
| Q0162 |
Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
654 |
646 |
$285.02 |
| 90716 |
|
13 |
13 |
$273.70 |
| 73140 |
|
84 |
83 |
$259.06 |
| 80326 |
|
286 |
266 |
$245.05 |
| 80347 |
|
286 |
266 |
$245.05 |
| 80364 |
|
286 |
266 |
$235.05 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
4,527 |
4,305 |
$230.50 |
| 82533 |
|
15 |
14 |
$223.31 |
| 84155 |
|
995 |
966 |
$216.78 |
| 86787 |
|
83 |
81 |
$184.25 |
| 84460 |
|
59 |
54 |
$176.51 |
| 86038 |
|
28 |
28 |
$152.48 |
| 73080 |
|
40 |
38 |
$146.39 |
| 88304 |
|
101 |
66 |
$136.71 |
| 99407 |
|
24 |
24 |
$134.85 |
| 84550 |
|
43 |
36 |
$122.04 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,387 |
2,350 |
$98.77 |
| 96376 |
|
372 |
307 |
$96.18 |
| 86580 |
|
16 |
15 |
$86.48 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
229 |
213 |
$75.90 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,709 |
1,687 |
$74.86 |
| 82330 |
|
12 |
12 |
$68.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
28 |
28 |
$59.30 |
| J3490 |
Unclassified drugs |
34 |
34 |
$58.28 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
3,834 |
3,647 |
$49.51 |
| 82248 |
|
18 |
12 |
$40.51 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,669 |
1,638 |
$32.25 |
| 96127 |
|
762 |
758 |
$30.92 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
449 |
449 |
$22.27 |
| J0689 |
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg |
289 |
288 |
$21.56 |
| J2704 |
Injection, propofol, 10 mg |
1,674 |
1,668 |
$10.97 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
346 |
300 |
$7.28 |
| 73090 |
|
12 |
12 |
$6.06 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
56 |
55 |
$4.84 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
300 |
283 |
$2.86 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
237 |
233 |
$2.64 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
20 |
17 |
$0.98 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
98 |
91 |
$0.91 |
| J2060 |
Injection, lorazepam, 2 mg |
165 |
149 |
$0.79 |
| A9270 |
Non-covered item or service |
75 |
55 |
$0.45 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
165 |
159 |
$0.27 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
566 |
550 |
$0.17 |
| 80329 |
|
859 |
820 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
88 |
83 |
$0.00 |
| 59430 |
|
26 |
26 |
$0.00 |
| 94729 |
|
12 |
12 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
28 |
28 |
$0.00 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
32 |
32 |
$0.00 |
| 80377 |
|
59 |
56 |
$0.00 |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
43 |
37 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
31 |
27 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
13 |
13 |
$0.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
17 |
13 |
$0.00 |