| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00731 |
|
686 |
623 |
$78K |
| 00811 |
|
482 |
426 |
$44K |
| 00813 |
|
329 |
290 |
$40K |
| 00812 |
|
97 |
88 |
$10K |
| A4649 |
Surgical supply; miscellaneous |
1,330 |
998 |
$2K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
1,795 |
1,474 |
$1K |
| E1399 |
Durable medical equipment, miscellaneous |
895 |
714 |
$398.12 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
2,073 |
1,509 |
$274.50 |
| 94760 |
|
904 |
777 |
$212.73 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
1,780 |
1,377 |
$16.23 |
| E1353 |
Regulator |
628 |
557 |
$15.50 |
| J2704 |
Injection, propofol, 10 mg |
1,232 |
934 |
$3.41 |
| S1015 |
Iv tubing extension set |
1,207 |
1,020 |
$2.69 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,331 |
996 |
$2.03 |
| E1354 |
Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each |
711 |
591 |
$0.00 |