| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpt clinic visit |
443,687 |
396,649 |
$35.69M |
| 99285 |
|
20,113 |
18,695 |
$8.84M |
| 99284 |
|
15,137 |
13,818 |
$4.01M |
| 99283 |
|
21,464 |
20,110 |
$3.59M |
| U0003 |
Cov-19 amp prb hgh thruput |
54,963 |
49,203 |
$3.19M |
| 92014 |
|
16,000 |
15,412 |
$1.38M |
| 67028 |
|
4,082 |
3,495 |
$769K |
| 96413 |
|
5,394 |
3,330 |
$745K |
| 41899 |
|
443 |
359 |
$647K |
| 92587 |
|
3,414 |
3,215 |
$590K |
| 0001A |
|
17,808 |
16,426 |
$546K |
| 92012 |
|
7,582 |
6,998 |
$541K |
| 0002A |
|
16,287 |
15,104 |
$522K |
| 92004 |
|
5,913 |
5,711 |
$519K |
| 93303 |
|
1,291 |
1,228 |
$487K |
| 96365 |
|
4,404 |
2,797 |
$462K |
| 76770 |
|
4,470 |
4,285 |
$449K |
| 17380 |
|
1,352 |
431 |
$409K |
| 96374 |
|
5,194 |
4,696 |
$376K |
| 93306 |
|
1,113 |
1,063 |
$341K |
| 77386 |
|
782 |
283 |
$301K |
| 42820 |
|
88 |
85 |
$291K |
| 97110 |
|
6,719 |
3,944 |
$248K |
| 99282 |
|
2,164 |
2,067 |
$217K |
| 43239 |
|
478 |
432 |
$195K |
| 70553 |
|
750 |
716 |
$192K |
| 11042 |
|
1,409 |
858 |
$186K |
| 74177 |
|
964 |
899 |
$174K |
| 80053 |
|
94,435 |
75,282 |
$166K |
| 93325 |
|
2,514 |
2,380 |
$166K |
| 92060 |
|
13,765 |
12,792 |
$151K |
| 31231 |
|
1,093 |
1,044 |
$138K |
| 69436 |
|
174 |
169 |
$114K |
| 97530 |
|
1,945 |
1,154 |
$107K |
| 99391 |
|
2,005 |
1,887 |
$102K |
| 90686 |
|
6,242 |
6,167 |
$98K |
| J0585 |
Injection,onabotulinumtoxina |
233 |
145 |
$91K |
| 0241U |
|
1,153 |
1,117 |
$89K |
| 85025 |
|
113,631 |
87,376 |
$88K |
| 0012A |
|
5,444 |
4,252 |
$86K |
| 96415 |
|
496 |
354 |
$81K |
| 96366 |
|
490 |
260 |
$80K |
| Q5103 |
Injection, inflectra |
96 |
88 |
$78K |
| J1750 |
Inj iron dextran |
356 |
342 |
$78K |
| 93798 |
|
1,191 |
220 |
$78K |
| 93005 |
|
21,180 |
18,750 |
$76K |
| 87635 |
|
4,016 |
3,188 |
$75K |
| 96375 |
|
4,589 |
3,025 |
$71K |
| 70551 |
|
416 |
387 |
$70K |
| 0004A |
|
2,160 |
2,047 |
$70K |
| 17111 |
|
520 |
484 |
$67K |
| 71046 |
|
3,027 |
2,816 |
$63K |
| 31579 |
|
250 |
238 |
$62K |
| 17999 |
|
714 |
654 |
$60K |
| 92567 |
|
8,469 |
8,007 |
$57K |
| 99392 |
|
899 |
890 |
$51K |
| 97803 |
|
1,805 |
1,702 |
$49K |
| 76512 |
|
546 |
500 |
$49K |
| 88305 |
|
6,482 |
5,951 |
$49K |
| 92250 |
|
3,287 |
3,066 |
$49K |
| 36415 |
|
96,175 |
81,460 |
$47K |
| 92134 |
|
11,886 |
10,525 |
$46K |
| 98941 |
|
2,739 |
1,956 |
$45K |
| G0378 |
Hospital observation per hr |
761 |
699 |
$45K |
| 59025 |
|
321 |
194 |
$43K |
| 0071A |
|
1,131 |
1,108 |
$41K |
| 91200 |
|
524 |
486 |
$41K |
| 87536 |
|
1,770 |
1,673 |
$39K |
| 92523 |
|
328 |
307 |
$38K |
| 86900 |
|
3,599 |
2,857 |
$38K |
| 99394 |
|
546 |
538 |
$38K |
| 0072A |
|
989 |
982 |
$37K |
| 96112 |
|
113 |
100 |
$36K |
| 99204 |
|
439 |
419 |
$36K |
| 11100 |
|
188 |
179 |
$36K |
| 96900 |
|
1,785 |
803 |
$33K |
| 93296 |
|
1,569 |
1,446 |
$32K |
| 92557 |
|
1,093 |
981 |
$31K |
| 84443 |
|
7,798 |
7,264 |
$31K |
| 99213 |
|
1,191 |
847 |
$30K |
| 90674 |
|
2,427 |
2,388 |
$30K |
| 17311 |
|
177 |
164 |
$29K |
| 90656 |
|
748 |
745 |
$28K |
| 97162 |
|
547 |
518 |
$28K |
| 99393 |
|
464 |
463 |
$28K |
| 52000 |
|
57 |
55 |
$27K |
| 80061 |
|
3,864 |
3,520 |
$27K |
| 90870 |
|
64 |
26 |
$26K |
| 0011A |
|
1,203 |
1,015 |
$25K |
| 51784 |
|
258 |
241 |
$25K |
| 0054A |
|
761 |
736 |
$24K |
| 82306 |
|
4,081 |
3,868 |
$23K |
| 11043 |
|
108 |
73 |
$22K |
| 29581 |
|
640 |
329 |
$22K |
| 92083 |
|
2,213 |
2,028 |
$22K |
| 76705 |
|
277 |
264 |
$22K |
| 96110 |
|
336 |
314 |
$21K |
| 99212 |
|
1,045 |
759 |
$21K |
| 76825 |
|
235 |
227 |
$20K |
| G0008 |
Admin influenza virus vac |
932 |
890 |
$19K |
| 73610 |
|
821 |
744 |
$19K |
| 82728 |
|
6,371 |
5,721 |
$19K |
| J0178 |
Aflibercept injection |
27 |
24 |
$18K |
| 76820 |
|
417 |
369 |
$17K |
| 45380 |
|
26 |
24 |
$17K |
| 87491 |
|
554 |
539 |
$17K |
| 87591 |
|
554 |
539 |
$17K |
| 87389 |
|
1,422 |
1,355 |
$15K |
| 73630 |
|
863 |
793 |
$15K |
| 98940 |
|
1,048 |
697 |
$15K |
| 86833 |
|
491 |
422 |
$15K |
| 80048 |
|
3,968 |
3,225 |
$15K |
| 86832 |
|
488 |
420 |
$15K |
| 36430 |
|
95 |
49 |
$14K |
| 97166 |
|
287 |
267 |
$14K |
| 92610 |
|
308 |
290 |
$14K |
| 94010 |
|
781 |
716 |
$13K |
| 64615 |
|
87 |
80 |
$13K |
| L4361 |
Pneuma/vac walk boot pre ots |
52 |
50 |
$13K |
| 0031A |
|
590 |
502 |
$13K |
| 90834 |
|
260 |
151 |
$13K |
| 95115 |
|
358 |
224 |
$13K |
| 83735 |
|
9,381 |
4,853 |
$12K |
| 97802 |
|
246 |
238 |
$11K |
| G0108 |
Diab manage trn per indiv |
150 |
140 |
$11K |
| 84403 |
|
1,289 |
1,153 |
$11K |
| J0475 |
Baclofen 10 mg injection |
30 |
24 |
$10K |
| 92002 |
|
165 |
156 |
$10K |
| 85027 |
|
7,339 |
6,393 |
$10K |
| C9257 |
Bevacizumab injection |
1,275 |
1,080 |
$10K |
| 99442 |
|
466 |
181 |
$9K |
| 83036 |
|
8,059 |
7,556 |
$9K |
| 76811 |
|
68 |
63 |
$9K |
| 91321 |
|
68 |
67 |
$9K |
| 76821 |
|
290 |
272 |
$9K |
| 20610 |
|
47 |
45 |
$9K |
| 90791 |
|
250 |
242 |
$9K |
| 70450 |
|
94 |
81 |
$8K |
| 77067 |
|
195 |
177 |
$8K |
| 96409 |
|
56 |
50 |
$8K |
| 86361 |
|
1,218 |
1,157 |
$8K |
| 11102 |
|
58 |
55 |
$8K |
| 80197 |
|
2,743 |
1,095 |
$8K |
| 82670 |
|
923 |
810 |
$8K |
| 98942 |
|
463 |
305 |
$7K |
| 92582 |
|
611 |
577 |
$7K |
| 76827 |
|
236 |
228 |
$7K |
| 71045 |
|
405 |
360 |
$7K |
| 84439 |
|
3,654 |
3,369 |
$7K |
| 71260 |
|
239 |
227 |
$7K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
5,363 |
4,265 |
$7K |
| 0003A |
|
225 |
209 |
$6K |
| 92133 |
|
1,997 |
1,882 |
$6K |
| 76816 |
|
501 |
393 |
$6K |
| 84100 |
|
8,047 |
3,849 |
$6K |
| 51741 |
|
689 |
662 |
$6K |
| 76700 |
|
120 |
109 |
$6K |
| 96372 |
|
932 |
675 |
$6K |
| 93793 |
|
1,139 |
562 |
$6K |
| 31575 |
|
51 |
49 |
$6K |
| 87086 |
|
1,780 |
1,633 |
$6K |
| 95004 |
|
13 |
12 |
$5K |
| 73130 |
|
255 |
218 |
$5K |
| 94761 |
|
42,554 |
40,322 |
$5K |
| 95117 |
|
166 |
101 |
$5K |
| 85610 |
|
9,003 |
6,445 |
$5K |
| 74018 |
|
1,439 |
1,355 |
$5K |
| 82784 |
|
819 |
732 |
$5K |
| G0480 |
Drug test def 1-7 classes |
124 |
113 |
$5K |
| 43235 |
|
13 |
13 |
$5K |
| 77336 |
|
54 |
24 |
$4K |
| 76536 |
|
223 |
204 |
$4K |
| 90670 |
|
276 |
273 |
$4K |
| 96361 |
|
17 |
12 |
$4K |
| 0202U |
|
14 |
14 |
$4K |
| 0111A |
|
123 |
121 |
$4K |
| 86850 |
|
3,479 |
2,748 |
$4K |
| Q3014 |
Telehealth facility fee |
746 |
629 |
$4K |
| 97167 |
|
74 |
69 |
$4K |
| 0112A |
|
108 |
107 |
$4K |
| 91320 |
|
26 |
26 |
$4K |
| 96130 |
|
70 |
64 |
$4K |
| 96101 |
|
51 |
50 |
$4K |
| 87799 |
|
486 |
320 |
$4K |
| 87522 |
Neg quan hep c or qual rna |
281 |
256 |
$4K |
| 20611 |
|
15 |
14 |
$3K |
| 96113 |
|
34 |
29 |
$3K |
| 90685 |
|
154 |
151 |
$3K |
| 87502 |
|
238 |
216 |
$3K |
| 83615 |
|
3,340 |
1,729 |
$3K |
| 86140 |
|
2,377 |
2,148 |
$3K |
| 92526 |
|
53 |
40 |
$3K |
| 80307 |
|
241 |
213 |
$3K |
| 81370 |
|
12 |
12 |
$3K |
| 92604 |
|
48 |
40 |
$3K |
| 81001 |
|
5,115 |
4,140 |
$3K |
| 84484 |
|
2,768 |
2,305 |
$3K |
| 82248 |
|
1,373 |
737 |
$3K |
| 90471 |
|
143 |
134 |
$3K |
| 99214 |
|
65 |
54 |
$3K |
| 88342 |
|
517 |
472 |
$3K |
| 93320 |
|
1,264 |
1,201 |
$3K |
| 71250 |
|
43 |
40 |
$2K |
| C9803 |
Hopd covid-19 spec collect |
2,870 |
2,216 |
$2K |
| 62370 |
|
30 |
24 |
$2K |
| 86803 |
|
371 |
358 |
$2K |
| 96131 |
|
39 |
37 |
$2K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
2,188 |
1,868 |
$2K |
| 86923 |
|
149 |
104 |
$2K |
| 92579 |
|
129 |
127 |
$2K |
| 72100 |
|
279 |
267 |
$2K |
| 84550 |
|
1,903 |
916 |
$2K |
| 83970 |
|
500 |
459 |
$2K |
| 0052A |
|
56 |
54 |
$2K |
| 87070 |
|
1,737 |
1,579 |
$2K |
| 83540 |
|
1,807 |
1,714 |
$2K |
| 92553 |
|
43 |
37 |
$2K |
| 90480 |
|
62 |
62 |
$2K |
| J1100 |
Dexamethasone sodium phos |
9,872 |
8,186 |
$2K |
| 86901 |
|
3,570 |
2,824 |
$2K |
| 86592 |
|
587 |
560 |
$2K |
| 73110 |
|
97 |
80 |
$2K |
| 90698 |
|
251 |
249 |
$2K |
| 0051A |
|
46 |
44 |
$2K |
| 17000 |
|
45 |
42 |
$2K |
| 83605 |
|
476 |
422 |
$1K |
| 73030 |
|
69 |
62 |
$1K |
| J3010 |
Fentanyl citrate injection |
9,276 |
8,054 |
$1K |
| 96150 |
|
12 |
12 |
$1K |
| 92522 |
|
17 |
17 |
$1K |
| 99215 |
Prolong outpt/office vis |
28 |
27 |
$1K |
| 98967 |
|
315 |
145 |
$1K |
| U0005 |
Infec agen detec ampli probe |
2,256 |
1,759 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
15,407 |
10,963 |
$1K |
| 71271 |
|
29 |
27 |
$1K |
| 84466 |
|
776 |
744 |
$1K |
| 93288 |
|
39 |
38 |
$1K |
| 74230 |
|
14 |
13 |
$1K |
| J2405 |
Ondansetron hcl injection |
10,407 |
8,300 |
$1K |
| 84146 |
|
308 |
289 |
$1K |
| 73590 |
|
76 |
63 |
$1K |
| 83880 |
|
230 |
212 |
$1K |
| 80069 |
|
468 |
389 |
$1K |
| 77073 |
|
310 |
297 |
$1K |
| 36591 |
|
106 |
64 |
$1K |
| 77080 |
|
34 |
32 |
$1K |
| 0124A |
|
26 |
26 |
$987.92 |
| 82105 |
|
426 |
377 |
$982.66 |
| 83550 |
|
788 |
741 |
$976.99 |
| 92504 |
|
2,601 |
2,416 |
$959.12 |
| 82570 |
|
1,042 |
849 |
$948.50 |
| 92235 |
|
13 |
12 |
$923.55 |
| J2250 |
Inj midazolam hydrochloride |
4,790 |
4,255 |
$922.44 |
| 85652 |
|
2,234 |
2,055 |
$916.39 |
| 96367 |
|
40 |
25 |
$909.67 |
| 87077 |
|
1,191 |
1,103 |
$900.60 |
| 88185 |
|
34 |
29 |
$888.78 |
| 81513 |
|
28 |
25 |
$887.60 |
| 71275 |
|
13 |
13 |
$856.50 |
| 72083 |
|
12 |
12 |
$834.89 |
| 87634 |
|
133 |
120 |
$831.69 |
| 83690 |
|
1,631 |
1,480 |
$781.79 |
| 90680 |
|
104 |
104 |
$772.94 |
| 96402 |
|
27 |
24 |
$760.36 |
| 85730 |
|
1,054 |
943 |
$718.22 |
| 96111 |
|
28 |
28 |
$716.73 |
| 77063 |
|
87 |
74 |
$709.70 |
| 81003 |
|
6,918 |
6,464 |
$699.39 |
| 0064A |
|
29 |
25 |
$682.98 |
| 83521 |
|
219 |
187 |
$671.39 |
| 69210 |
|
340 |
305 |
$646.96 |
| J1170 |
Hydromorphone injection |
1,471 |
1,066 |
$624.44 |
| 92524 |
|
12 |
12 |
$613.02 |
| 96411 |
|
19 |
12 |
$609.62 |
| J2001 |
Lidocaine injection |
2,422 |
2,254 |
$597.80 |
| 98943 |
|
49 |
29 |
$588.95 |
| 90677 |
|
68 |
68 |
$588.26 |
| 80076 |
|
265 |
206 |
$583.91 |
| 87186 |
|
990 |
940 |
$569.34 |
| 87497 |
|
109 |
63 |
$561.80 |
| 98968 |
|
45 |
26 |
$547.95 |
| 74455 |
|
12 |
12 |
$519.89 |
| 90651 |
|
24 |
24 |
$514.96 |
| 87517 |
|
27 |
26 |
$510.31 |
| 84703 |
|
921 |
863 |
$508.06 |
| 88184 |
|
37 |
30 |
$449.35 |
| 81376 |
|
12 |
12 |
$445.82 |
| 73560 |
|
55 |
50 |
$445.17 |
| J1885 |
Ketorolac tromethamine inj |
4,257 |
2,983 |
$417.68 |
| C1769 |
Guide wire |
1,167 |
1,060 |
$416.64 |
| 94760 |
|
4,974 |
4,773 |
$414.09 |
| 82565 |
|
664 |
618 |
$395.95 |
| 73502 |
|
25 |
25 |
$395.35 |
| 87661 |
|
28 |
25 |
$395.08 |
| 72148 |
|
12 |
12 |
$395.00 |
| 51798 |
|
338 |
312 |
$394.23 |
| 84432 |
|
163 |
128 |
$389.04 |
| 87481 |
|
28 |
25 |
$370.97 |
| 87811 |
|
15 |
15 |
$362.03 |
| 72082 |
|
84 |
82 |
$359.25 |
| 97535 |
|
13 |
12 |
$357.45 |
| 87081 |
|
79 |
78 |
$354.85 |
| 86800 |
|
173 |
143 |
$347.68 |
| 92025 |
|
52 |
50 |
$342.69 |
| 36592 |
|
178 |
101 |
$342.52 |
| 72110 |
|
72 |
67 |
$330.03 |
| 92552 |
|
15 |
13 |
$317.92 |
| 86780 |
|
26 |
26 |
$307.11 |
| 83921 |
|
209 |
196 |
$305.42 |
| 82024 |
|
67 |
63 |
$280.65 |
| 92611 |
|
15 |
14 |
$274.56 |
| 84156 |
|
450 |
327 |
$259.41 |
| 72170 |
|
27 |
25 |
$257.59 |
| 90744 |
|
12 |
12 |
$251.44 |
| 11721 |
|
33 |
29 |
$251.05 |
| 90723 |
|
28 |
28 |
$237.06 |
| J0690 |
Cefazolin sodium injection |
3,181 |
2,565 |
$229.00 |
| 82607 |
|
315 |
294 |
$225.87 |
| 84425 |
|
219 |
206 |
$222.29 |
| 83090 |
|
205 |
192 |
$222.16 |
| 93282 |
|
15 |
13 |
$213.95 |
| 87340 |
|
196 |
189 |
$213.11 |
| J2270 |
Morphine sulfate injection |
1,601 |
1,310 |
$210.19 |
| Q0162 |
Ondansetron oral |
1,332 |
1,139 |
$205.50 |
| 86480 |
|
57 |
54 |
$199.71 |
| 82533 |
|
92 |
81 |
$188.21 |
| 86334 |
|
131 |
116 |
$146.99 |
| G1004 |
Cdsm ndsc |
8,574 |
5,828 |
$143.49 |
| 92285 |
|
171 |
163 |
$141.34 |
| 73564 |
|
56 |
54 |
$138.33 |
| 82803 |
|
193 |
174 |
$132.06 |
| 86003 |
|
13 |
13 |
$115.36 |
| 87205 |
|
178 |
151 |
$107.36 |
| 86704 |
|
92 |
90 |
$106.10 |
| 83516 |
|
142 |
136 |
$102.36 |
| 80305 |
|
487 |
310 |
$102.23 |
| 86706 |
|
88 |
83 |
$97.60 |
| C1894 |
Intro/sheath, non-laser |
150 |
135 |
$96.26 |
| J3490 |
Drugs unclassified injection |
283 |
263 |
$95.56 |
| 72050 |
|
26 |
25 |
$91.44 |
| 88341 |
|
59 |
54 |
$79.77 |
| 87880 |
|
105 |
104 |
$66.10 |
| 93356 |
|
66 |
61 |
$65.36 |
| 84702 |
|
39 |
37 |
$55.52 |
| 84165 |
|
143 |
128 |
$53.48 |
| 84305 |
|
116 |
104 |
$49.89 |
| 83883 |
|
15 |
12 |
$44.33 |
| 84132 |
|
15 |
14 |
$43.18 |
| J0171 |
Adrenalin epinephrine inject |
84 |
74 |
$40.38 |
| 84630 |
|
53 |
50 |
$39.46 |
| J1642 |
Inj heparin sodium per 10 u |
2,171 |
1,221 |
$35.95 |
| 87040 |
|
66 |
63 |
$33.92 |
| 86364 |
|
14 |
14 |
$31.17 |
| 81015 |
|
42 |
39 |
$29.23 |
| 85384 |
|
86 |
78 |
$28.76 |
| 82977 |
|
29 |
28 |
$26.62 |
| 84134 |
|
43 |
38 |
$20.62 |
| 84590 |
|
38 |
36 |
$17.90 |
| J7030 |
Normal saline solution infus |
31 |
12 |
$17.68 |
| 36416 |
|
5,334 |
3,675 |
$15.24 |
| 82378 |
|
34 |
27 |
$15.17 |
| 84446 |
|
25 |
24 |
$11.00 |
| 82525 |
|
25 |
24 |
$9.00 |
| 82043 |
|
13 |
13 |
$8.76 |
| 82550 |
|
15 |
12 |
$7.68 |
| 86645 |
|
15 |
13 |
$2.81 |
| 86644 |
|
15 |
13 |
$2.40 |
| 86762 |
|
13 |
12 |
$2.40 |
| 86708 |
|
41 |
37 |
$2.06 |
| J1200 |
Diphenhydramine hcl injectio |
164 |
122 |
$2.02 |
| J2710 |
Neostigmine methylslfte inj |
106 |
90 |
$0.40 |
| 91311 |
|
178 |
177 |
$0.17 |
| J1756 |
Iron sucrose injection |
74 |
26 |
$0.00 |
| C1887 |
Catheter, guiding |
101 |
90 |
$0.00 |
| G8978 |
Mobility current status |
132 |
126 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
329 |
312 |
$0.00 |
| 90611 |
|
44 |
40 |
$0.00 |
| 92555 |
|
66 |
63 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
107 |
98 |
$0.00 |
| L8613 |
Ossicular implant |
99 |
94 |
$0.00 |
| J3370 |
Vancomycin hcl injection |
29 |
28 |
$0.00 |
| 96136 |
|
68 |
63 |
$0.00 |
| G8979 |
Mobility goal status |
133 |
126 |
$0.00 |
| 87660 |
|
12 |
12 |
$0.00 |
| J3260 |
Tobramycin sulfate injection |
30 |
28 |
$0.00 |
| 87641 |
|
43 |
38 |
$0.00 |
| J9370 |
Vincristine sulfate 1 mg inj |
30 |
25 |
$0.00 |
| J1644 |
Inj heparin sodium per 1000u |
21 |
12 |
$0.00 |
| J8499 |
Oral prescrip drug non chemo |
27 |
24 |
$0.00 |
| J9190 |
Fluorouracil injection |
44 |
13 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
14 |
13 |
$0.00 |
| A4306 |
Drug delivery system <=50 ml |
13 |
12 |
$0.00 |
| 96137 |
|
14 |
14 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
73 |
68 |
$0.00 |
| 11045 |
|
21 |
12 |
$0.00 |
| 95886 |
|
215 |
199 |
$0.00 |
| 51736 |
|
17 |
16 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
57 |
50 |
$0.00 |
| A9573 |
Inj, gadopiclenol, 1 ml |
41 |
40 |
$0.00 |
| 87640 |
|
42 |
37 |
$0.00 |
| 87480 |
|
12 |
12 |
$0.00 |
| 76815 |
|
108 |
83 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
109 |
71 |
$0.00 |
| 51600 |
|
12 |
12 |
$0.00 |
| J1597 |
Inj glycopyrrolate, glyrx-pf |
14 |
12 |
$0.00 |
| 80047 |
|
25 |
24 |
$0.00 |
| J7999 |
Compounded drug, noc |
28 |
25 |
$0.00 |
| 90647 |
|
13 |
13 |
$0.00 |
| 96376 |
|
14 |
12 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
28 |
27 |
$0.00 |
| 87510 |
|
12 |
12 |
$0.00 |
| 76377 |
|
15 |
13 |
$0.00 |
| 82657 |
|
18 |
14 |
$0.00 |