| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
1,232 |
594 |
$129K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
3,390 |
1,611 |
$59K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
347 |
172 |
$21K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,305 |
1,251 |
$18K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
1,152 |
716 |
$15K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
61 |
40 |
$2K |
| J9190 |
Injection, fluorouracil, 500 mg |
108 |
39 |
$1K |