| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00731 |
|
761 |
460 |
$38K |
| 00811 |
|
454 |
287 |
$21K |
| A4222 |
Infusion supplies with pump |
1,649 |
1,143 |
$20K |
| 00812 |
|
339 |
207 |
$15K |
| 93040 |
|
1,861 |
1,221 |
$14K |
| 00813 |
|
159 |
97 |
$9K |
| A4670 |
Automatic bp monitor, dial |
1,555 |
993 |
$5K |
| E0780 |
Mech amb infusion pump <8hrs |
1,485 |
967 |
$4K |
| E1399 |
Durable medical equipment mi |
5,059 |
1,062 |
$3K |
| A4628 |
Oropharyngeal suction cath |
1,607 |
1,102 |
$2K |
| E1353 |
Oxygen supplies regulator |
1,565 |
962 |
$1K |
| A4649 |
Surgical supplies |
215 |
150 |
$1K |
| E0424 |
Stationary compressed gas 02 |
1,499 |
949 |
$1K |
| E1354 |
Wheeled cart, port cyl/conc |
1,565 |
964 |
$932.87 |
| E0445 |
Oximeter non-invasive |
121 |
77 |
$791.91 |
| E0600 |
Suction pump portab hom modl |
1,507 |
970 |
$715.65 |
| A4208 |
3 cc sterile syringe&needle |
1,877 |
1,183 |
$281.85 |
| J2704 |
Inj, propofol, 10 mg |
2,269 |
976 |
$150.65 |
| J7643 |
Glycopyrrolate comp unit |
175 |
131 |
$107.47 |
| 94760 |
|
2,117 |
1,079 |
$106.02 |
| R0076 |
Transport portable ekg |
1,557 |
957 |
$70.55 |
| J1885 |
Ketorolac tromethamine inj |
130 |
108 |
$69.10 |
| E0617 |
Automatic ext defibrillator |
1,655 |
920 |
$68.44 |
| J7040 |
Normal saline solution infus |
111 |
89 |
$53.33 |
| J3010 |
Fentanyl citrate injection |
160 |
128 |
$44.64 |
| J2001 |
Lidocaine injection |
1,661 |
997 |
$32.99 |
| J2405 |
Ondansetron hcl injection |
170 |
138 |
$29.27 |