| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00731 |
|
101 |
92 |
$15K |
| 00811 |
|
90 |
84 |
$13K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
519 |
499 |
$533.76 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
400 |
350 |
$96.50 |
| J2704 |
Injection, propofol, 10 mg |
534 |
506 |
$83.36 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
574 |
474 |
$2.49 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
132 |
118 |
$0.00 |
| E1399 |
Durable medical equipment, miscellaneous |
89 |
81 |
$0.00 |
| S1015 |
Iv tubing extension set |
98 |
97 |
$0.00 |