| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
756 |
685 |
$31K |
| 43239 |
|
59 |
59 |
$16K |
| 99213 |
|
264 |
229 |
$10K |
| 81003 |
|
1,081 |
964 |
$3K |
| 99212 |
|
75 |
69 |
$3K |
| J3490 |
Unclassified drugs |
4,415 |
1,969 |
$1K |
| 88305 |
|
252 |
224 |
$991.55 |
| 85025 |
|
125 |
98 |
$661.44 |
| 87491 |
|
25 |
24 |
$593.70 |
| 87591 |
|
25 |
24 |
$468.60 |
| 86850 |
|
84 |
80 |
$341.20 |
| 86901 |
|
97 |
92 |
$249.27 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
2,491 |
1,613 |
$214.87 |
| 86900 |
|
84 |
80 |
$166.34 |
| 80053 |
|
20 |
13 |
$154.94 |
| 87086 |
|
14 |
14 |
$113.60 |
| 84703 |
|
13 |
13 |
$79.03 |
| J7999 |
Compounded drug, not otherwise classified |
1,796 |
934 |
$74.45 |
| 81025 |
|
14 |
14 |
$39.60 |
| J2704 |
Injection, propofol, 10 mg |
5,853 |
3,931 |
$36.66 |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
56 |
46 |
$15.06 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
4,015 |
3,522 |
$14.15 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
2,016 |
1,857 |
$8.05 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
3,319 |
3,174 |
$7.42 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,280 |
2,147 |
$4.16 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
1,388 |
1,249 |
$4.04 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
649 |
572 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,376 |
1,230 |
$0.00 |
| J0670 |
Injection, mepivacaine hydrochloride, per 10 ml |
493 |
482 |
$0.00 |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
531 |
388 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
823 |
798 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
149 |
134 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
30 |
30 |
$0.00 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
214 |
195 |
$0.00 |
| J0137 |
Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg |
131 |
123 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
146 |
120 |
$0.00 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
252 |
237 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
14 |
12 |
$0.00 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
44 |
40 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
719 |
599 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
2,114 |
1,903 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
27 |
26 |
$0.00 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
174 |
170 |
$0.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
119 |
113 |
$0.00 |
| J1626 |
Injection, granisetron hydrochloride, 100 mcg |
15 |
15 |
$0.00 |