| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
14,781 |
3,455 |
$895K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
8,554 |
3,070 |
$143K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
1,679 |
338 |
$106K |
| J3490 |
Unclassified drugs |
953 |
180 |
$57K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
496 |
264 |
$43K |
| E0776 |
Iv pole |
1,117 |
681 |
$41K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
2,809 |
333 |
$27K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
212 |
68 |
$24K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
595 |
107 |
$18K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
308 |
150 |
$12K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,684 |
667 |
$7K |
| B9002 |
Enteral nutrition infusion pump, any type |
131 |
100 |
$7K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
1,162 |
459 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
556 |
393 |
$4K |
| J9190 |
Injection, fluorouracil, 500 mg |
130 |
59 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
150 |
50 |
$720.34 |
| Y9167 |
|
363 |
268 |
$715.33 |
| J7050 |
Infusion, normal saline solution, 250 cc |
96 |
44 |
$379.99 |
| J1644 |
Injection, heparin sodium, per 1000 units |
353 |
188 |
$178.05 |
| E1399 |
Durable medical equipment, miscellaneous |
78 |
41 |
$11.20 |