| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3490 |
Unclassified drugs |
639 |
400 |
$31.63 |
| J2704 |
Injection, propofol, 10 mg |
189 |
168 |
$2.80 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
110 |
104 |
$0.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
268 |
262 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
164 |
162 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
362 |
277 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
55 |
53 |
$0.00 |
| 85730 |
|
26 |
24 |
$0.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
271 |
256 |
$0.00 |
| 85610 |
|
27 |
25 |
$0.00 |
| 85049 |
|
14 |
12 |
$0.00 |