| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1170 |
Hydromorphone injection |
937 |
713 |
$995.58 |
| J1100 |
Dexamethasone sodium phos |
2,156 |
2,019 |
$900.59 |
| J2704 |
Inj, propofol, 10 mg |
2,358 |
2,269 |
$853.53 |
| J3010 |
Fentanyl citrate injection |
3,000 |
2,211 |
$612.10 |
| 81025 |
|
141 |
139 |
$434.00 |
| 82947 |
|
113 |
85 |
$382.94 |
| J2405 |
Ondansetron hcl injection |
2,271 |
2,080 |
$361.44 |
| C1769 |
Guide wire |
13 |
13 |
$343.09 |
| J0690 |
Cefazolin sodium injection |
896 |
743 |
$338.07 |
| J2250 |
Inj midazolam hydrochloride |
2,111 |
2,000 |
$302.08 |
| J1885 |
Ketorolac tromethamine inj |
1,222 |
974 |
$191.29 |
| 74240 |
|
14 |
13 |
$145.25 |
| J1644 |
Inj heparin sodium per 1000u |
157 |
98 |
$41.42 |
| 36415 |
|
31 |
26 |
$41.25 |
| 85027 |
|
15 |
13 |
$22.56 |
| 80051 |
|
14 |
13 |
$21.00 |
| 82565 |
|
14 |
13 |
$19.23 |
| 84520 |
|
14 |
13 |
$16.32 |
| J7120 |
Ringers lactate infusion |
1,097 |
1,002 |
$10.45 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
20 |
20 |
$0.00 |
| J3490 |
Drugs unclassified injection |
907 |
739 |
$0.00 |
| S0020 |
Injection, bupivicaine hydro |
15 |
14 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
567 |
549 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
168 |
161 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
58 |
47 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
17 |
16 |
$0.00 |