| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0112 |
|
30 |
27 |
$494K |
| 0121 |
|
19 |
19 |
$107K |
| 0450 |
|
470 |
408 |
$22K |
| J3490 |
Drugs unclassified injection |
463 |
226 |
$8K |
| 0360 |
|
85 |
44 |
$8K |
| 96374 |
|
73 |
67 |
$7K |
| 96375 |
|
54 |
45 |
$3K |
| 0171 |
Inj, epinephrine (belcher) |
12 |
12 |
$3K |
| 93005 |
|
83 |
78 |
$3K |
| 80053 |
|
220 |
198 |
$2K |
| 96361 |
|
53 |
42 |
$2K |
| 0750 |
|
12 |
12 |
$2K |
| 0510 |
|
53 |
47 |
$2K |
| 85025 |
|
239 |
214 |
$2K |
| 80307 |
|
22 |
15 |
$2K |
| 96365 |
|
17 |
17 |
$2K |
| 96360 |
|
16 |
14 |
$2K |
| 77067 |
|
14 |
14 |
$1K |
| 87502 |
|
12 |
12 |
$1K |
| 76815 |
|
20 |
13 |
$1K |
| 0710 |
|
48 |
48 |
$909.44 |
| 71045 |
|
70 |
67 |
$751.14 |
| 76801 |
|
15 |
15 |
$720.52 |
| 84484 |
|
65 |
54 |
$682.18 |
| 71046 |
|
41 |
41 |
$674.32 |
| 86703 |
|
40 |
40 |
$581.39 |
| 86803 |
|
37 |
37 |
$572.14 |
| J7030 |
Normal saline solution infus |
52 |
44 |
$512.22 |
| J2704 |
Inj, propofol, 10 mg |
43 |
37 |
$482.10 |
| 83690 |
|
66 |
59 |
$472.15 |
| J2405 |
Ondansetron hcl injection |
62 |
52 |
$432.45 |
| 87086 |
|
37 |
37 |
$382.39 |
| 83605 |
|
29 |
17 |
$377.00 |
| J2001 |
Lidocaine injection |
55 |
45 |
$374.09 |
| J3010 |
Fentanyl citrate injection |
41 |
37 |
$308.75 |
| 84702 |
|
18 |
17 |
$291.09 |
| J1885 |
Ketorolac tromethamine inj |
31 |
27 |
$260.79 |
| 81001 |
|
78 |
76 |
$259.19 |
| J1100 |
Dexamethasone sodium phos |
32 |
31 |
$246.76 |
| J2250 |
Inj midazolam hydrochloride |
35 |
35 |
$241.44 |
| 0250 |
|
100 |
93 |
$207.40 |
| S0020 |
Injection, bupivicaine hydro |
14 |
14 |
$198.38 |
| 84703 |
|
20 |
19 |
$157.74 |
| J2270 |
Morphine sulfate injection |
17 |
16 |
$153.68 |
| 82947 |
|
19 |
13 |
$142.04 |
| J0690 |
Cefazolin sodium injection |
15 |
15 |
$138.30 |
| 81025 |
|
22 |
22 |
$113.89 |
| 87400 |
|
20 |
20 |
$88.74 |
| 85610 |
|
20 |
20 |
$84.03 |
| 0301 |
|
97 |
91 |
$60.23 |
| 85014 |
|
13 |
12 |
$33.03 |
| 0302 |
|
70 |
66 |
$30.39 |
| 0305 |
|
98 |
91 |
$26.67 |
| 0306 |
|
73 |
69 |
$21.68 |
| 0324 |
|
40 |
39 |
$10.79 |
| 0730 |
|
47 |
46 |
$8.22 |
| 0307 |
|
57 |
54 |
$1.51 |
| 0258 |
|
74 |
71 |
$1.43 |
| 0460 |
|
17 |
16 |
$0.00 |
| 0300 |
|
39 |
38 |
$0.00 |
| 0272 |
|
47 |
45 |
$0.00 |
| 0402 |
|
33 |
31 |
$0.00 |
| 0489 |
|
17 |
16 |
$0.00 |
| 0352 |
|
13 |
13 |
$0.00 |
| 0721 |
|
32 |
32 |
$0.00 |
| 0949 |
|
39 |
37 |
$0.00 |
| 0255 |
|
12 |
12 |
$0.00 |
| J7620 |
Albuterol ipratrop non-comp |
15 |
15 |
$0.00 |
| 0420 |
|
15 |
15 |
$0.00 |