| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 43239 |
|
22 |
12 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
1,792 |
1,467 |
$9.65 |
| J3010 |
Fentanyl citrate injection |
1,067 |
843 |
$2.53 |
| J2250 |
Inj midazolam hydrochloride |
954 |
835 |
$0.49 |
| J2405 |
Ondansetron hcl injection |
737 |
646 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
199 |
190 |
$0.00 |
| J0137 |
Inj, acetaminophen (hikma) |
29 |
29 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
13 |
13 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
44 |
40 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
698 |
629 |
$0.00 |
| J3490 |
Drugs unclassified injection |
1,021 |
847 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
222 |
186 |
$0.00 |
| 88305 |
|
136 |
91 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
130 |
99 |
$0.00 |