| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J0585 |
Injection,onabotulinumtoxina |
5,334 |
5,047 |
$6.38M |
| J1726 |
Makena, 10 mg |
2,554 |
1,163 |
$3.39M |
| S0013 |
Esketamine, nasal spray |
1,695 |
772 |
$2.39M |
| A4222 |
Infusion supplies with pump |
11,346 |
4,595 |
$2.10M |
| J1729 |
Inj hydroxyprogst capoat nos |
371 |
185 |
$273K |
| E0780 |
Mech amb infusion pump <8hrs |
3,580 |
1,550 |
$232K |
| A4221 |
Supp non-insulin inf cath/wk |
9,985 |
4,672 |
$218K |
| J1950 |
Leuprolide acetate /3.75 mg |
70 |
63 |
$135K |
| A4216 |
Sterile water/saline, 10 ml |
9,133 |
4,075 |
$75K |
| E0779 |
Amb infusion pump mechanical |
406 |
309 |
$47K |
| A4213 |
20+ cc syringe only |
3,060 |
1,283 |
$30K |
| B4224 |
Parenteral administration ki |
82 |
50 |
$20K |
| A4212 |
Non coring needle or stylet |
1,995 |
1,298 |
$18K |
| A4245 |
Alcohol wipes per box |
4,120 |
3,568 |
$17K |
| J1642 |
Inj heparin sodium per 10 u |
978 |
547 |
$16K |
| J0897 |
Denosumab injection |
13 |
13 |
$16K |
| E0776 |
Iv pole |
1,410 |
1,156 |
$11K |
| A4452 |
Waterproof tape |
1,445 |
1,318 |
$10K |
| A4209 |
5+ cc sterile syringe&needle |
5,889 |
2,487 |
$6K |
| A4215 |
Sterile needle |
6,412 |
3,608 |
$4K |
| E0781 |
External ambulatory infus pu |
35 |
13 |
$2K |
| E1390 |
Oxygen concentrator |
76 |
76 |
$2K |
| A4206 |
1 cc sterile syringe&needle |
1,384 |
1,234 |
$935.80 |
| J0171 |
Adrenalin epinephrine inject |
216 |
206 |
$753.59 |
| A6402 |
Sterile gauze <= 16 sq in |
1,292 |
1,175 |
$233.86 |
| A4208 |
3 cc sterile syringe&needle |
92 |
75 |
$52.20 |