| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 01930 |
|
539 |
398 |
$69K |
| 01967 |
|
61 |
55 |
$23K |
| A4649 |
Surgical supplies |
823 |
557 |
$8K |
| A4222 |
Infusion supplies with pump |
762 |
553 |
$7K |
| 00910 |
|
85 |
85 |
$7K |
| J3490 |
Drugs unclassified injection |
460 |
290 |
$4K |
| E0445 |
Oximeter non-invasive |
557 |
346 |
$3K |
| E1399 |
Durable medical equipment mi |
1,380 |
346 |
$3K |
| E0485 |
Oral device/appliance prefab |
237 |
154 |
$611.68 |
| E1353 |
Oxygen supplies regulator |
489 |
302 |
$593.22 |
| J7030 |
Normal saline solution infus |
764 |
561 |
$450.99 |
| A4615 |
Cannula nasal |
803 |
567 |
$157.62 |
| E1354 |
Wheeled cart, port cyl/conc |
561 |
347 |
$116.48 |
| J1094 |
Inj dexamethasone acetate |
206 |
148 |
$110.17 |
| J2704 |
Inj, propofol, 10 mg |
230 |
166 |
$105.51 |
| A4670 |
Automatic bp monitor, dial |
197 |
153 |
$75.05 |
| J2405 |
Ondansetron hcl injection |
662 |
478 |
$63.67 |
| J7643 |
Glycopyrrolate comp unit |
325 |
226 |
$44.75 |
| J1885 |
Ketorolac tromethamine inj |
168 |
111 |
$41.19 |
| A4213 |
20+ cc syringe only |
1,071 |
572 |
$26.25 |
| A4207 |
2 cc sterile syringe&needle |
1,076 |
574 |
$17.17 |
| J2001 |
Lidocaine injection |
480 |
316 |
$13.52 |
| R0076 |
Transport portable ekg |
556 |
334 |
$0.00 |
| 99070 |
|
968 |
474 |
$0.00 |