| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 43239 |
|
25 |
25 |
$2K |
| 88305 |
|
60 |
56 |
$308.07 |
| J3490 |
Drugs unclassified injection |
812 |
363 |
$180.99 |
| J3010 |
Fentanyl citrate injection |
1,132 |
1,031 |
$18.83 |
| J2704 |
Inj, propofol, 10 mg |
1,272 |
962 |
$9.76 |
| 81025 |
|
13 |
13 |
$4.80 |
| J2250 |
Inj midazolam hydrochloride |
1,182 |
1,108 |
$3.45 |
| J2405 |
Ondansetron hcl injection |
990 |
853 |
$3.24 |
| J2001 |
Lidocaine injection |
895 |
780 |
$1.88 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
134 |
130 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
145 |
139 |
$0.00 |
| J1644 |
Inj heparin sodium per 1000u |
41 |
31 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
16 |
13 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
13 |
13 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
136 |
121 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
404 |
394 |
$0.00 |
| J1170 |
Hydromorphone injection |
292 |
224 |
$0.00 |
| J7999 |
Compounded drug, noc |
138 |
80 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
15 |
15 |
$0.00 |