| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2315 |
Injection, naltrexone, depot form, 1 mg |
297 |
276 |
$445K |
| S0013 |
Esketamine, nasal spray, 1 mg |
169 |
85 |
$350K |
| 90378 |
|
236 |
60 |
$252K |
| J0741 |
Injection, cabotegravir and rilpivirine, 2mg/3mg |
18 |
12 |
$67K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
399 |
374 |
$7K |
| S9562 |
Home injectable therapy, palivizumab or other monoclonal antibody for rsv, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
91 |
81 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
42 |
38 |
$0.00 |