| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
1,711 |
515 |
$28K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
1,489 |
104 |
$26K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
142 |
24 |
$7K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
728 |
528 |
$4K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
412 |
24 |
$1K |
| J7050 |
Infusion, normal saline solution, 250 cc |
106 |
65 |
$570.34 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
12 |
12 |
$3.84 |