| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 64483 |
|
104 |
99 |
$10K |
| 64484 |
|
73 |
70 |
$2K |
| A4215 |
Needle, sterile, any size, each |
180 |
159 |
$10.62 |
| J7799 |
Noc drugs, other than inhalation drugs, administered through dme |
123 |
110 |
$0.00 |
| A4930 |
Gloves, sterile, per pair |
180 |
159 |
$0.00 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
154 |
134 |
$0.00 |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
176 |
156 |
$0.00 |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
180 |
160 |
$0.00 |
| A6208 |
Contact layer, sterile, more than 48 sq. in., each dressing |
180 |
160 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
154 |
138 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
106 |
94 |
$0.00 |
| A6206 |
Contact layer, sterile, 16 sq. in. or less, each dressing |
179 |
159 |
$0.00 |
| A4246 |
Betadine or phisohex solution, per pint |
154 |
134 |
$0.00 |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
179 |
159 |
$0.00 |
| Q9962 |
High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml |
137 |
120 |
$0.00 |