| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 88305 |
|
53 |
51 |
$779.78 |
| J2704 |
Inj, propofol, 10 mg |
2,051 |
1,697 |
$188.86 |
| J0690 |
Cefazolin sodium injection |
719 |
599 |
$145.49 |
| J3010 |
Fentanyl citrate injection |
2,346 |
1,611 |
$92.66 |
| 84703 |
|
27 |
24 |
$61.92 |
| J3490 |
Drugs unclassified injection |
1,742 |
1,204 |
$58.12 |
| J2405 |
Ondansetron hcl injection |
1,774 |
1,433 |
$37.51 |
| J1100 |
Dexamethasone sodium phos |
1,483 |
1,333 |
$25.73 |
| J2250 |
Inj midazolam hydrochloride |
1,590 |
1,451 |
$24.85 |
| J1885 |
Ketorolac tromethamine inj |
679 |
578 |
$0.73 |
| J1170 |
Hydromorphone injection |
238 |
186 |
$0.00 |
| A4215 |
Sterile needle |
12 |
12 |
$0.00 |
| J1644 |
Inj heparin sodium per 1000u |
131 |
111 |
$0.00 |
| J2270 |
Morphine sulfate injection |
291 |
254 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
142 |
137 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
26 |
24 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
21 |
17 |
$0.00 |