| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
43 |
42 |
$831.60 |
| J3490 |
Unclassified drugs |
538 |
330 |
$321.38 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
636 |
614 |
$29.38 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
658 |
632 |
$4.25 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
689 |
665 |
$2.92 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
681 |
595 |
$1.32 |
| J2704 |
Injection, propofol, 10 mg |
32 |
29 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
435 |
354 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
235 |
225 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
296 |
293 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
203 |
165 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
47 |
46 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
132 |
127 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
18 |
15 |
$0.00 |