| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
5,334 |
5,047 |
$6.38M |
| J1726 |
Injection, hydroxyprogesterone caproate, (makena), 10 mg |
2,554 |
1,163 |
$3.39M |
| S0013 |
Esketamine, nasal spray, 1 mg |
1,695 |
772 |
$2.39M |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
11,346 |
4,595 |
$2.10M |
| J1729 |
Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg |
371 |
185 |
$273K |
| E0780 |
Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours |
3,580 |
1,550 |
$232K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
9,985 |
4,672 |
$218K |
| J1950 |
Injection, leuprolide acetate (for depot suspension), per 3.75 mg |
70 |
63 |
$135K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
9,133 |
4,075 |
$75K |
| E0779 |
Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater |
406 |
309 |
$47K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
3,060 |
1,283 |
$30K |
| B4224 |
Parenteral nutrition administration kit, per day |
82 |
50 |
$20K |
| A4212 |
Non-coring needle or stylet with or without catheter |
1,995 |
1,298 |
$18K |
| A4245 |
Alcohol wipes, per box |
4,120 |
3,568 |
$17K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
978 |
547 |
$16K |
| J0897 |
Injection, denosumab, 1 mg |
13 |
13 |
$16K |
| E0776 |
Iv pole |
1,410 |
1,156 |
$11K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,445 |
1,318 |
$10K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
5,889 |
2,487 |
$6K |
| A4215 |
Needle, sterile, any size, each |
6,412 |
3,608 |
$4K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
35 |
13 |
$2K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
76 |
76 |
$2K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
1,384 |
1,234 |
$935.80 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
216 |
206 |
$753.59 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,292 |
1,175 |
$233.86 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
92 |
75 |
$52.20 |