| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
6,284 |
2,141 |
$117K |
| A4217 |
Sterile water/saline, 500 ml |
1,007 |
767 |
$93K |
| E0776 |
Iv pole |
1,216 |
1,162 |
$87K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
698 |
603 |
$63K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
1,684 |
1,362 |
$37K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
1,308 |
1,118 |
$32K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
2,526 |
1,808 |
$20K |
| A4215 |
Needle, sterile, any size, each |
635 |
544 |
$9K |
| S9374 |
Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
17 |
16 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
2,259 |
1,805 |
$4K |
| A4649 |
Surgical supply; miscellaneous |
1,198 |
1,059 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,809 |
1,522 |
$2K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
948 |
836 |
$2K |
| A4245 |
Alcohol wipes, per box |
2,323 |
1,859 |
$996.44 |
| A4452 |
Tape, waterproof, per 18 square inches |
458 |
433 |
$633.05 |
| A4248 |
Chlorhexidine containing antiseptic, 1 ml |
16 |
16 |
$468.24 |
| S1015 |
Iv tubing extension set |
136 |
124 |
$420.37 |
| A4421 |
Ostomy supply; miscellaneous |
12 |
12 |
$22.34 |