| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00731 |
|
12 |
12 |
$3K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
18 |
14 |
$470.71 |
| A4649 |
Surgical supply; miscellaneous |
21 |
14 |
$175.98 |
| A4615 |
Cannula, nasal |
17 |
13 |
$3.78 |
| J2704 |
Injection, propofol, 10 mg |
32 |
14 |
$1.30 |
| R0076 |
Transportation of portable ekg to facility or location, per patient |
19 |
15 |
$0.00 |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
16 |
12 |
$0.00 |
| E1353 |
Regulator |
17 |
12 |
$0.00 |
| A4207 |
Syringe with needle, sterile 2 cc, each |
19 |
15 |
$0.00 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
19 |
15 |
$0.00 |
| E1354 |
Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each |
16 |
12 |
$0.00 |
| E1399 |
Durable medical equipment, miscellaneous |
45 |
12 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
32 |
14 |
$0.00 |