| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 43239 |
|
161 |
158 |
$16K |
| 66984 |
|
16 |
13 |
$14K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
47 |
43 |
$11K |
| 45380 |
|
44 |
43 |
$9K |
| 88305 |
|
322 |
308 |
$5K |
| 88342 |
|
143 |
132 |
$4K |
| 45385 |
|
13 |
13 |
$3K |
| C1769 |
Guide wire |
94 |
92 |
$2K |
| J1170 |
Hydromorphone injection |
414 |
370 |
$414.62 |
| C1894 |
Intro/sheath, non-laser |
65 |
65 |
$380.11 |
| J0690 |
Cefazolin sodium injection |
1,149 |
1,081 |
$376.23 |
| J3010 |
Fentanyl citrate injection |
3,128 |
2,748 |
$354.38 |
| 82962 |
|
327 |
251 |
$276.84 |
| J2704 |
Inj, propofol, 10 mg |
1,753 |
1,660 |
$225.81 |
| 81025 |
|
143 |
140 |
$199.88 |
| 80048 |
|
54 |
32 |
$185.92 |
| J1100 |
Dexamethasone sodium phos |
2,255 |
2,193 |
$164.44 |
| J2405 |
Ondansetron hcl injection |
2,866 |
2,612 |
$88.24 |
| J0330 |
Succinycholine chloride inj |
41 |
41 |
$58.97 |
| J2250 |
Inj midazolam hydrochloride |
2,509 |
2,455 |
$56.24 |
| 88304 |
|
16 |
14 |
$44.88 |
| 85025 |
|
18 |
12 |
$37.80 |
| 85027 |
|
19 |
13 |
$34.60 |
| J1885 |
Ketorolac tromethamine inj |
183 |
179 |
$24.77 |
| 36415 |
|
49 |
48 |
$19.05 |
| J2370 |
Phenylephrine hcl injection |
105 |
102 |
$18.03 |
| J1644 |
Inj heparin sodium per 1000u |
107 |
89 |
$17.50 |
| J1580 |
Garamycin gentamicin inj |
28 |
28 |
$8.95 |
| J0131 |
Inj, acetaminophen (nos) |
108 |
107 |
$0.00 |
| J7050 |
Normal saline solution infus |
251 |
208 |
$0.00 |
| C9399 |
Unclassified drugs or biolog |
151 |
148 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
80 |
73 |
$0.00 |
| J7060 |
5% dextrose/water |
29 |
27 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
42 |
33 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
25 |
25 |
$0.00 |
| J0689 |
Inj cefazolin sodium, baxter |
12 |
12 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
166 |
165 |
$0.00 |