| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00170 |
|
14,126 |
13,659 |
$11.13M |
| D9222 |
|
666 |
653 |
$492K |
| D9223 |
|
1,179 |
1,112 |
$385K |
| J2405 |
Ondansetron hcl injection |
12,158 |
11,712 |
$18K |
| J1100 |
Dexamethasone sodium phos |
5,971 |
5,710 |
$14K |
| J1885 |
Ketorolac tromethamine inj |
10,602 |
10,233 |
$12K |
| J2704 |
Inj, propofol, 10 mg |
12,157 |
11,707 |
$9K |
| J7642 |
Glycopyrrolate comp con |
11,824 |
11,404 |
$2K |
| J3490 |
Drugs unclassified injection |
11,206 |
10,526 |
$2K |
| 31000 |
|
19 |
17 |
$2K |
| J0131 |
Inj, acetaminophen (nos) |
467 |
466 |
$882.32 |
| 69209 |
|
20 |
18 |
$135.24 |
| J2250 |
Inj midazolam hydrochloride |
10,942 |
10,675 |
$75.08 |
| A4217 |
Sterile water/saline, 500 ml |
9,706 |
9,332 |
$28.11 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
19 |
19 |
$4.94 |
| A4216 |
Sterile water/saline, 10 ml |
20 |
20 |
$0.00 |