| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1170 |
Injection, hydromorphone, up to 4 mg |
937 |
713 |
$995.58 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,156 |
2,019 |
$900.59 |
| J2704 |
Injection, propofol, 10 mg |
2,358 |
2,269 |
$853.53 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,000 |
2,211 |
$612.10 |
| 81025 |
|
141 |
139 |
$434.00 |
| 82947 |
|
113 |
85 |
$382.94 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
2,271 |
2,080 |
$361.44 |
| C1769 |
Guide wire |
13 |
13 |
$343.09 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
896 |
743 |
$338.07 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,111 |
2,000 |
$302.08 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
1,222 |
974 |
$191.29 |
| 74240 |
|
14 |
13 |
$145.25 |
| J1644 |
Injection, heparin sodium, per 1000 units |
157 |
98 |
$41.42 |
| 36415 |
Collection of venous blood by venipuncture |
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, up to 1000 cc |
1,097 |
1,002 |
$10.45 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
20 |
20 |
$0.00 |
| J3490 |
Unclassified drugs |
907 |
739 |
$0.00 |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
15 |
14 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
567 |
549 |
$0.00 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
168 |
161 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
58 |
47 |
$0.00 |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
17 |
16 |
$0.00 |