| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
22 |
12 |
$1K |
| J2704 |
Injection, propofol, 10 mg |
1,792 |
1,467 |
$9.65 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,067 |
843 |
$2.53 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
954 |
835 |
$0.49 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
737 |
646 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
199 |
190 |
$0.00 |
| J0137 |
Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg |
29 |
29 |
$0.00 |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
13 |
13 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
44 |
40 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
698 |
629 |
$0.00 |
| J3490 |
Unclassified drugs |
1,021 |
847 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
222 |
186 |
$0.00 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
136 |
91 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
130 |
99 |
$0.00 |