| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
160,208 |
138,983 |
$14.12M |
| 99199 |
|
84,825 |
71,242 |
$9.43M |
| 87633 |
|
7,357 |
7,013 |
$4.13M |
| 74177 |
|
9,482 |
9,121 |
$3.38M |
| 70450 |
|
13,136 |
12,653 |
$3.05M |
| 87637 |
|
10,239 |
9,981 |
$2.37M |
| 99283 |
|
21,502 |
18,122 |
$2.31M |
| 0202U |
|
4,653 |
4,553 |
$2.05M |
| 87636 |
|
9,719 |
9,414 |
$1.98M |
| 80307 |
|
19,031 |
17,412 |
$1.86M |
| 96374 |
|
20,985 |
19,058 |
$1.80M |
| 99281 |
|
13,301 |
11,631 |
$1.74M |
| 80053 |
|
97,243 |
87,273 |
$1.70M |
| 93005 |
|
41,672 |
37,725 |
$1.63M |
| J3490 |
Drugs unclassified injection |
99,337 |
50,305 |
$1.58M |
| 0270 |
|
43,935 |
23,612 |
$1.49M |
| 87635 |
|
20,352 |
19,519 |
$1.43M |
| 71046 |
|
38,492 |
36,558 |
$1.42M |
| 85025 |
|
122,794 |
107,353 |
$1.37M |
| 96365 |
|
13,286 |
10,601 |
$1.34M |
| 0762 |
|
1,795 |
698 |
$1.29M |
| Z7502 |
|
28,835 |
28,432 |
$1.07M |
| 96375 |
|
17,874 |
15,018 |
$1.03M |
| 99202 |
|
4,634 |
3,562 |
$1.00M |
| 96372 |
|
26,492 |
22,866 |
$1.00M |
| T1999 |
Noc retail items andsupplies |
34,627 |
17,554 |
$982K |
| 72125 |
|
3,134 |
3,058 |
$969K |
| 99499 |
|
13,031 |
10,628 |
$903K |
| 74176 |
|
4,862 |
4,728 |
$902K |
| Z4300 |
|
8,131 |
8,089 |
$839K |
| 0160 |
|
2,463 |
1,188 |
$770K |
| 76705 |
|
7,521 |
7,219 |
$711K |
| 87798 |
|
8,050 |
7,648 |
$709K |
| 99285 |
|
3,694 |
3,359 |
$694K |
| 99284 |
|
5,316 |
4,846 |
$683K |
| 83880 |
|
16,810 |
15,591 |
$670K |
| 82077 |
|
6,514 |
6,200 |
$628K |
| 93971 |
|
3,694 |
3,559 |
$600K |
| 71275 |
|
1,833 |
1,799 |
$594K |
| 87486 |
|
8,455 |
8,125 |
$585K |
| 84484 |
|
38,795 |
25,460 |
$584K |
| 87581 |
|
8,455 |
8,124 |
$578K |
| 41899 |
|
1,045 |
1,012 |
$573K |
| 87491 |
|
8,925 |
8,625 |
$572K |
| Z4304 |
|
7,212 |
7,193 |
$558K |
| 96361 |
|
11,046 |
9,633 |
$555K |
| 87591 |
|
8,642 |
8,355 |
$544K |
| 71260 |
|
1,382 |
1,321 |
$492K |
| 0250 |
|
16,022 |
7,816 |
$480K |
| Z9725 |
|
11,046 |
11,015 |
$475K |
| 76801 |
|
5,043 |
4,433 |
$468K |
| 70486 |
|
1,741 |
1,709 |
$466K |
| 76856 |
|
4,459 |
4,335 |
$463K |
| 96360 |
|
5,066 |
4,532 |
$459K |
| 87502 |
|
4,248 |
4,093 |
$456K |
| 83690 |
|
39,401 |
36,508 |
$427K |
| 93306 |
|
1,715 |
1,652 |
$426K |
| 87086 |
|
36,280 |
34,148 |
$417K |
| 0510 |
|
8,019 |
6,174 |
$392K |
| U0003 |
Cov-19 amp prb hgh thruput |
6,973 |
6,780 |
$385K |
| 76815 |
|
16,698 |
11,068 |
$375K |
| 71045 |
|
15,953 |
15,178 |
$373K |
| 70551 |
|
658 |
649 |
$367K |
| 76830 |
|
3,360 |
3,263 |
$351K |
| 99201 |
|
2,494 |
1,943 |
$350K |
| 76817 |
|
3,813 |
3,375 |
$344K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
23,608 |
13,950 |
$337K |
| 87040 |
|
16,580 |
11,773 |
$334K |
| 96413 |
|
4,190 |
2,594 |
$330K |
| 96376 |
|
1,172 |
896 |
$324K |
| Z7500 |
|
9,109 |
8,767 |
$310K |
| 87651 |
|
5,330 |
5,263 |
$299K |
| 93970 |
|
1,104 |
1,077 |
$291K |
| 95700 |
|
619 |
602 |
$289K |
| 81001 |
|
53,903 |
50,116 |
$289K |
| 80048 |
|
17,430 |
16,075 |
$261K |
| 95714 |
|
273 |
164 |
$256K |
| 80143 |
|
2,326 |
2,184 |
$250K |
| 59025 |
|
29,518 |
10,549 |
$243K |
| 82803 |
|
8,892 |
8,044 |
$242K |
| Z4301 |
|
7,531 |
7,405 |
$237K |
| J7030 |
Normal saline solution infus |
19,941 |
16,254 |
$235K |
| Z4308 |
|
7,309 |
7,206 |
$222K |
| 80179 |
|
2,093 |
2,024 |
$218K |
| Z5946 |
|
87 |
87 |
$216K |
| 83605 |
|
13,782 |
11,198 |
$216K |
| 81025 |
|
24,971 |
23,706 |
$211K |
| T1024 |
Team evaluation & management |
3,154 |
1,913 |
$209K |
| 96366 |
|
3,693 |
2,761 |
$208K |
| 76700 |
|
1,533 |
1,504 |
$195K |
| 73630 |
|
4,784 |
4,598 |
$192K |
| 87507 |
|
269 |
267 |
$182K |
| J0131 |
Inj, acetaminophen (nos) |
4,486 |
2,739 |
$182K |
| 94640 |
|
5,407 |
4,643 |
$172K |
| 73610 |
|
3,961 |
3,840 |
$172K |
| Z4307 |
|
6,492 |
6,396 |
$171K |
| 73130 |
|
3,769 |
3,610 |
$169K |
| 0760 |
|
5,733 |
4,785 |
$169K |
| 84702 |
|
15,097 |
13,786 |
$168K |
| J1885 |
Ketorolac tromethamine inj |
17,604 |
16,398 |
$164K |
| 72100 |
|
3,312 |
3,258 |
$159K |
| G9002 |
Mccd,maintenance rate |
1,141 |
1,102 |
$158K |
| 84145 |
|
5,303 |
5,119 |
$155K |
| 73030 |
|
3,565 |
3,439 |
$153K |
| 84443 |
|
6,184 |
5,927 |
$152K |
| 73562 |
|
3,788 |
3,658 |
$151K |
| 76770 |
|
1,194 |
1,146 |
$146K |
| 86923 |
|
1,500 |
1,015 |
$139K |
| 83735 |
|
14,151 |
12,276 |
$137K |
| 78452 |
|
342 |
332 |
$137K |
| 90715 |
|
2,272 |
2,237 |
$134K |
| 96367 |
|
2,264 |
1,848 |
$132K |
| S0302 |
Completed epsdt |
1,478 |
760 |
$129K |
| 74018 |
|
4,064 |
3,910 |
$123K |
| J2405 |
Ondansetron hcl injection |
13,699 |
11,600 |
$121K |
| 73502 |
|
1,688 |
1,616 |
$120K |
| J7120 |
Ringers lactate infusion |
11,090 |
10,003 |
$119K |
| J2785 |
Regadenoson injection |
383 |
368 |
$113K |
| J0696 |
Ceftriaxone sodium injection |
8,943 |
8,119 |
$110K |
| J1100 |
Dexamethasone sodium phos |
9,775 |
8,924 |
$104K |
| A9502 |
Tc99m tetrofosmin |
409 |
394 |
$102K |
| 85730 |
|
11,060 |
10,449 |
$100K |
| X4500 |
|
1,058 |
1,057 |
$100K |
| 73110 |
|
2,281 |
2,195 |
$100K |
| 81003 |
|
26,713 |
25,337 |
$98K |
| 96112 |
|
603 |
603 |
$97K |
| 99282 |
|
903 |
814 |
$96K |
| Z4311 |
|
7,792 |
7,746 |
$94K |
| 80076 |
|
7,522 |
7,203 |
$94K |
| 86140 |
|
11,073 |
10,610 |
$92K |
| Z7610 |
|
9,645 |
5,167 |
$92K |
| 0710 |
|
587 |
558 |
$89K |
| 85379 |
|
5,104 |
4,927 |
$87K |
| Z4312 |
|
7,058 |
7,010 |
$85K |
| 85610 |
|
14,897 |
13,925 |
$84K |
| T1001 |
Nursing assessment/evaluatn |
1,083 |
1,033 |
$82K |
| 95810 |
|
172 |
167 |
$80K |
| 0360 |
|
347 |
288 |
$80K |
| 87186 |
|
8,891 |
8,186 |
$79K |
| 87077 |
|
9,323 |
8,372 |
$76K |
| J2270 |
Morphine sulfate injection |
6,413 |
5,372 |
$76K |
| 73080 |
|
1,684 |
1,639 |
$75K |
| Z5910 |
|
1,587 |
1,556 |
$74K |
| 99368 |
|
2,339 |
1,271 |
$70K |
| 70498 |
|
210 |
209 |
$70K |
| 76870 |
|
847 |
818 |
$67K |
| 72131 |
|
250 |
244 |
$66K |
| 86850 |
|
5,886 |
5,570 |
$65K |
| 73590 |
|
1,862 |
1,775 |
$65K |
| 94644 |
|
2,024 |
1,843 |
$65K |
| X4301 |
|
680 |
679 |
$64K |
| 82330 |
|
3,053 |
2,752 |
$62K |
| 87430 |
|
4,005 |
3,884 |
$60K |
| J2704 |
Inj, propofol, 10 mg |
4,363 |
3,190 |
$59K |
| 95811 |
|
99 |
96 |
$58K |
| X4540 |
|
1,736 |
1,729 |
$57K |
| J1200 |
Diphenhydramine hcl injectio |
5,188 |
4,343 |
$57K |
| 87081 |
|
4,537 |
4,390 |
$56K |
| 86901 |
|
9,411 |
8,607 |
$54K |
| J1745 |
Infliximab not biosimil 10mg |
33 |
26 |
$54K |
| 72040 |
|
1,231 |
1,217 |
$53K |
| 70496 |
|
165 |
162 |
$52K |
| 95816 |
|
458 |
452 |
$49K |
| 93017 |
|
534 |
515 |
$48K |
| 72070 |
|
1,026 |
1,014 |
$47K |
| 87400 |
|
4,969 |
4,660 |
$47K |
| 92557 |
|
249 |
240 |
$47K |
| G0378 |
Hospital observation per hr |
395 |
267 |
$44K |
| 73090 |
|
1,264 |
1,209 |
$44K |
| J1815 |
Insulin injection |
4,011 |
2,048 |
$43K |
| 82947 |
|
7,291 |
6,286 |
$42K |
| 95819 |
|
416 |
411 |
$41K |
| 99401 |
|
1,517 |
1,368 |
$39K |
| 74019 |
|
880 |
857 |
$39K |
| 92567 |
|
568 |
550 |
$39K |
| Z4310 |
|
3,126 |
3,117 |
$38K |
| J2001 |
Lidocaine injection |
3,712 |
3,322 |
$38K |
| 86900 |
|
8,478 |
6,887 |
$37K |
| 99070 |
|
1,071 |
673 |
$35K |
| 73140 |
|
1,154 |
1,131 |
$34K |
| Z4302 |
|
2,634 |
2,624 |
$34K |
| 70491 |
|
95 |
95 |
$34K |
| 99366 |
|
1,143 |
808 |
$34K |
| Z5928 |
|
673 |
673 |
$32K |
| P9016 |
Rbc leukocytes reduced |
109 |
92 |
$31K |
| 82552 |
|
1,593 |
1,315 |
$31K |
| 96415 |
|
759 |
546 |
$31K |
| 82550 |
|
3,316 |
2,800 |
$30K |
| 10060 |
|
951 |
929 |
$30K |
| J3010 |
Fentanyl citrate injection |
3,722 |
3,370 |
$30K |
| J2765 |
Metoclopramide hcl injection |
3,237 |
2,909 |
$30K |
| 76816 |
|
441 |
402 |
$29K |
| J2060 |
Lorazepam injection |
3,370 |
2,716 |
$28K |
| 83036 |
|
1,792 |
1,706 |
$28K |
| 84703 |
|
4,994 |
4,880 |
$28K |
| J7040 |
Normal saline solution infus |
2,660 |
2,316 |
$27K |
| 70553 |
|
26 |
26 |
$27K |
| 80061 |
|
1,866 |
1,773 |
$27K |
| V5264 |
Ear mold/insert |
517 |
516 |
$27K |
| Z4306 |
|
367 |
367 |
$26K |
| 0761 |
|
558 |
464 |
$26K |
| 36415 |
|
19,137 |
16,918 |
$26K |
| J2930 |
Methylprednisolone injection |
1,528 |
1,298 |
$26K |
| 97803 |
|
612 |
595 |
$26K |
| J7050 |
Normal saline solution infus |
4,403 |
2,226 |
$24K |
| J1170 |
Hydromorphone injection |
1,681 |
1,198 |
$24K |
| 95708 |
|
47 |
24 |
$23K |
| 43239 |
|
174 |
164 |
$23K |
| J3480 |
Inj potassium chloride |
474 |
340 |
$22K |
| 85027 |
|
2,638 |
2,309 |
$22K |
| S0164 |
Injection pantroprazole |
1,154 |
877 |
$22K |
| J0561 |
Penicillin g benzathine inj |
69 |
67 |
$22K |
| 73560 |
|
732 |
682 |
$22K |
| J2250 |
Inj midazolam hydrochloride |
2,645 |
2,495 |
$22K |
| J3475 |
Inj magnesium sulfate |
1,866 |
1,308 |
$21K |
| 71020 |
|
490 |
171 |
$20K |
| 87634 |
|
253 |
248 |
$19K |
| Z4309 |
|
775 |
774 |
$19K |
| 88305 |
|
794 |
535 |
$19K |
| 87210 |
|
2,375 |
2,332 |
$18K |
| 90471 |
|
2,652 |
2,487 |
$18K |
| 87070 |
|
1,358 |
1,280 |
$17K |
| Z7506 |
|
297 |
296 |
$17K |
| G0463 |
Hospital outpt clinic visit |
1,080 |
954 |
$17K |
| 93976 |
|
53 |
53 |
$17K |
| 87420 |
|
1,298 |
1,222 |
$17K |
| 84132 |
|
3,277 |
2,950 |
$16K |
| J1650 |
Inj enoxaparin sodium |
1,008 |
555 |
$16K |
| 71250 |
|
59 |
56 |
$16K |
| 0272 |
|
40 |
26 |
$16K |
| Q0162 |
Ondansetron oral |
1,350 |
1,281 |
$15K |
| 36430 |
|
27 |
25 |
$15K |
| 99244 |
|
268 |
256 |
$15K |
| 85652 |
|
3,817 |
3,671 |
$15K |
| U0005 |
Infec agen detec ampli probe |
2,478 |
2,420 |
$15K |
| 80164 |
|
682 |
610 |
$14K |
| 93325 |
|
70 |
68 |
$14K |
| 96111 |
|
130 |
130 |
$14K |
| 84439 |
|
1,165 |
1,125 |
$13K |
| J1644 |
Inj heparin sodium per 1000u |
940 |
498 |
$13K |
| A9585 |
Gadobutrol injection |
122 |
105 |
$13K |
| 99080 |
|
126 |
126 |
$13K |
| 97597 |
|
217 |
106 |
$13K |
| 96417 |
|
187 |
122 |
$12K |
| 0324 |
|
255 |
245 |
$12K |
| J0690 |
Cefazolin sodium injection |
1,058 |
883 |
$12K |
| 84295 |
|
2,580 |
2,393 |
$12K |
| 87205 |
|
1,769 |
1,657 |
$12K |
| J1756 |
Iron sucrose injection |
538 |
96 |
$11K |
| 97750 |
|
138 |
121 |
$11K |
| 96113 |
|
156 |
156 |
$11K |
| Z5406 |
|
332 |
327 |
$11K |
| 90732 |
|
74 |
66 |
$11K |
| 87147 |
|
1,588 |
936 |
$11K |
| 42820 |
|
104 |
100 |
$11K |
| 82140 |
|
621 |
552 |
$10K |
| S0028 |
Injection, famotidine, 20 mg |
660 |
591 |
$10K |
| 71100 |
|
197 |
190 |
$9K |
| 86592 |
|
2,056 |
2,012 |
$9K |
| 0301 |
|
193 |
183 |
$9K |
| 92526 |
|
107 |
101 |
$9K |
| 95953 |
|
12 |
12 |
$8K |
| J0360 |
Hydralazine hcl injection |
603 |
488 |
$8K |
| J7620 |
Albuterol ipratrop non-comp |
2,879 |
2,505 |
$8K |
| J0780 |
Prochlorperazine injection |
395 |
371 |
$8K |
| 84550 |
|
1,541 |
1,414 |
$8K |
| J7611 |
Albuterol non-comp con |
3,476 |
3,219 |
$7K |
| 82731 |
|
652 |
609 |
$7K |
| 90686 |
|
205 |
190 |
$7K |
| 93320 |
|
56 |
54 |
$7K |
| J7512 |
Prednisone ir or dr oral 1mg |
2,705 |
2,435 |
$7K |
| 73552 |
|
175 |
171 |
$7K |
| 12001 |
|
144 |
139 |
$7K |
| 83615 |
|
941 |
868 |
$7K |
| 00000 |
|
215 |
200 |
$6K |
| 87389 |
|
215 |
215 |
$6K |
| 29125 |
|
349 |
331 |
$6K |
| S0077 |
Injection, clindamycin phosp |
265 |
230 |
$6K |
| J1940 |
Furosemide injection |
478 |
347 |
$6K |
| 87088 |
|
807 |
792 |
$6K |
| J2560 |
Phenobarbital sodium inj |
40 |
37 |
$5K |
| J7510 |
Prednisolone oral per 5 mg |
1,161 |
1,096 |
$5K |
| 12011 |
|
118 |
117 |
$5K |
| J7644 |
Ipratropium bromide non-comp |
1,308 |
1,240 |
$5K |
| 0121 |
|
12 |
12 |
$5K |
| 82565 |
|
740 |
669 |
$5K |
| J8540 |
Oral dexamethasone |
1,825 |
1,196 |
$5K |
| J1630 |
Haloperidol injection |
507 |
420 |
$5K |
| 82570 |
|
1,154 |
1,010 |
$5K |
| 96156 |
|
201 |
192 |
$5K |
| 45380 |
|
31 |
26 |
$5K |
| 0516 |
|
77 |
73 |
$5K |
| 84450 |
|
740 |
659 |
$4K |
| 86308 |
|
544 |
536 |
$4K |
| 84460 |
|
724 |
646 |
$4K |
| 73060 |
|
139 |
133 |
$4K |
| 94729 |
|
217 |
199 |
$4K |
| J2550 |
Promethazine hcl injection |
443 |
409 |
$4K |
| 97530 |
|
137 |
82 |
$4K |
| 94726 |
|
237 |
220 |
$4K |
| Q4051 |
Splint supplies misc |
26 |
21 |
$4K |
| 96402 |
|
145 |
128 |
$4K |
| 84100 |
|
833 |
496 |
$4K |
| J3370 |
Vancomycin hcl injection |
241 |
173 |
$4K |
| J0137 |
Inj, acetaminophen (hikma) |
163 |
98 |
$4K |
| 70360 |
|
151 |
140 |
$4K |
| 82728 |
|
262 |
245 |
$4K |
| 97802 |
|
107 |
81 |
$4K |
| 96523 |
|
56 |
51 |
$4K |
| 84112 |
|
857 |
808 |
$4K |
| 98967 |
|
40 |
40 |
$4K |
| 71010 |
|
127 |
46 |
$3K |
| 81015 |
|
688 |
671 |
$3K |
| J2919 |
Inj, methylpred sod succ 5mg |
156 |
147 |
$3K |
| 84156 |
|
1,121 |
972 |
$3K |
| 87045 |
|
185 |
180 |
$3K |
| J1642 |
Inj heparin sodium per 10 u |
617 |
244 |
$3K |
| 94645 |
|
129 |
121 |
$3K |
| 0391 |
|
34 |
26 |
$3K |
| J1953 |
Levetiracetam injection |
144 |
81 |
$3K |
| J1453 |
Fosaprepitant injection |
79 |
36 |
$3K |
| 93303 |
|
14 |
14 |
$3K |
| 50590 |
|
13 |
13 |
$3K |
| 99403 |
|
46 |
46 |
$3K |
| 82247 |
|
856 |
657 |
$3K |
| 87427 |
|
167 |
162 |
$2K |
| 87015 |
|
198 |
189 |
$2K |
| 82270 |
|
461 |
448 |
$2K |
| Z6406 |
|
88 |
79 |
$2K |
| 87046 |
|
229 |
180 |
$2K |
| 69436 |
|
12 |
12 |
$1K |
| 73100 |
|
42 |
38 |
$1K |
| 93750 |
|
13 |
12 |
$1K |
| 82248 |
|
228 |
190 |
$1K |
| 0309 |
|
84 |
80 |
$1K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
206 |
85 |
$1K |
| 12002 |
|
26 |
26 |
$1K |
| J2003 |
Inj, lidocaine hcl, 1 mg |
61 |
54 |
$1K |
| 97162 |
|
13 |
12 |
$1K |
| 0320 |
|
18 |
17 |
$1K |
| J2300 |
Inj nalbuphine hydrochloride |
76 |
73 |
$1K |
| 93798 |
|
51 |
12 |
$977.94 |
| 97161 |
|
16 |
16 |
$939.53 |
| J3360 |
Diazepam injection |
29 |
24 |
$926.58 |
| 82010 |
|
66 |
64 |
$886.04 |
| 87075 |
|
67 |
62 |
$858.12 |
| 80074 |
|
13 |
13 |
$821.58 |
| 94010 |
|
63 |
61 |
$770.67 |
| 72170 |
|
26 |
25 |
$684.65 |
| 83540 |
|
110 |
102 |
$676.81 |
| 82805 |
|
15 |
13 |
$620.26 |
| 90384 |
|
13 |
13 |
$606.73 |
| S0020 |
Injection, bupivicaine hydro |
41 |
39 |
$515.10 |
| 73000 |
|
12 |
12 |
$513.90 |
| Z6204 |
|
26 |
25 |
$494.60 |
| 83550 |
|
78 |
73 |
$466.72 |
| 82553 |
|
18 |
16 |
$433.75 |
| J3411 |
Thiamine hcl 100 mg |
50 |
41 |
$415.66 |
| G8978 |
Mobility current status |
151 |
145 |
$390.75 |
| Z7512 |
|
14 |
14 |
$365.82 |
| 94060 |
|
12 |
12 |
$364.51 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
16 |
12 |
$353.04 |
| J2470 |
Inj pantoprazole sodium 40mg |
46 |
41 |
$344.31 |
| 96151 |
|
17 |
16 |
$325.95 |
| 88300 |
|
54 |
51 |
$322.39 |
| J7613 |
Albuterol non-comp unit |
403 |
368 |
$217.98 |
| J3105 |
Terbutaline sulfate inj |
17 |
14 |
$216.29 |
| 29105 |
|
13 |
13 |
$184.46 |
| Z6304 |
|
13 |
13 |
$180.92 |
| J0330 |
Succinycholine chloride inj |
12 |
12 |
$168.31 |
| J1956 |
Levofloxacin injection |
14 |
14 |
$148.90 |
| 0306 |
|
58 |
53 |
$142.63 |
| J0280 |
Aminophyllin 250 mg inj |
18 |
14 |
$136.40 |
| J0456 |
Azithromycin |
12 |
12 |
$133.84 |
| 99404 |
|
24 |
24 |
$107.94 |
| 36600 |
|
14 |
12 |
$84.29 |
| G8979 |
Mobility goal status |
150 |
143 |
$61.13 |
| 80197 |
|
23 |
14 |
$9.77 |
| 0730 |
|
12 |
12 |
$0.00 |
| 0250R |
|
70 |
64 |
$0.00 |
| 0305 |
|
85 |
79 |
$0.00 |
| 0307 |
|
12 |
12 |
$0.00 |
| G8980 |
Mobility d/c status |
27 |
26 |
$0.00 |
| 0258 |
|
12 |
12 |
$0.00 |
| J2543 |
Piperacillin/tazobactam |
17 |
14 |
$0.00 |