Home › Billing code B4104
B4104
Additive for enteral formula (e.g., fiber)
Medicaid paid $6.13M on code B4104 from 2018 through 2024, to 44 providers — the #2,395 code in the file by dollars. 73% of it was billed in Texas.
28Total paid$6.13M
24GClaims67,314
Paid per claim line$91.04
33Providers billing it44
Box 32 · Location
Where B4104 is billed
The largest of 11 states and territories, by the billing provider's address. States cover different services and set their own rates, so the same code can mean different things in different programs.
Ranked
Top providers billing B4104
| # | Provider | Location | Claims | Paid on B4104 |
|---|---|---|---|---|
| 1 | Option 1 Nutrition Solutions LLC | Denver, CO | 14,766 | $1.09M |
| 2 | Medco Respiratory Instruments, INC. | Houston, TX | 9,039 | $923K |
| 3 | Angel Medical Supply LLC | Houston, TX | 1,986 | $745K |
| 4 | Apple Homecare Medical Supply LLC | Richardson, TX | 4,735 | $404K |
| 5 | Aapex Community Pharmacy INC | Houston, TX | 976 | $400K |
| 6 | TCG Interests, LLC | Houston, TX | 2,845 | $384K |
| 7 | Wave Healthcare | San Antonio, TX | 2,425 | $364K |
| 8 | Urs Sub I, LLC | Waco, TX | 3,946 | $342K |
| 9 | Alliance Medical Supply, LLC | San Antonio, TX | 2,171 | $265K |
| 10 | Tender Care Pediatric Services, INC | Loveland, CO | 2,249 | $197K |
| 11 | A&p Quality Care Medical Limited Partnership | Austin, TX | 2,238 | $189K |
| 12 | Cook Childrens Home Health | Fort Worth, TX | 903 | $153K |
| 13 | Medical Plus Supplies INC | Houston, TX | 1,740 | $113K |
| 14 | Option 1 Nutrition Solutions, LLC | Chandler, AZ | 4,186 | $76K |
| 15 | Entramed, INC | Tomball, TX | 1,305 | $74K |
| 16 | Wadsworth Medical Arts Pharmacy LLC | Arvada, CO | 935 | $71K |
| 17 | Ortho-Tek INC | Nacogdoches, TX | 1,197 | $64K |
| 18 | Palmetto Seating and Mobility, INC. | Anderson, SC | 488 | $63K |
| 19 | Lifehme, INC. | Columbia, SC | 485 | $49K |
| 20 | Lifehme, INC. | Florence, SC | 836 | $46K |
| 21 | Rocky Mountain Medical Equipment, INC. | Lakewood, CO | 335 | $22K |
| 22 | The Children's Mercy Hospital | Riverside, MO | 270 | $16K |
| 23 | Romo Medical Equipment, LLC | San Antonio, TX | 168 | $12K |
| 24 | Elite Medical & Mobility, LLC | Frisco, TX | 68 | $11K |
| 25 | Home Medical Equipment Specialists LLC | Albuquerque, NM | 103 | $10K |
| 26 | Option 1 Nutrition Solutions LLC | Tulsa, OK | 116 | $8K |
| 27 | Star Formula INC | Addison, TX | 96 | $7K |
| 28 | Option 1 Nutrition Solutions LLC | Charlotte, NC | 147 | $6K |
| 29 | Geisinger Pharmacy LLC | Danville, PA | 246 | $6K |
| 30 | Tender Care Pediatric Services, INC | Colorado Springs, CO | 52 | $6K |
| 31 | 1184653388 | 58 | $5K | |
| 32 | Joshua's Respiratory Care, INC | Dallas, TX | 39 | $3K |
| 33 | Special Needs Network | Arvada, CO | 45 | $3K |
| 34 | Medical Plus Supplies, INC. | Grand Prairie, TX | 28 | $2K |
| 35 | Coram Alternate Site Services, INC. | Phoenix, AZ | 1,516 | $1K |
| 36 | Hometown Oxygen Charlotte LLC | Concord, NC | 109 | $1K |
| 37 | Entramed, INC | Colorado Springs, CO | 25 | $1K |
| 38 | Founders Healthcare, LLC | Phoenix, AZ | 1,857 | $356.52 |
| 39 | 1013919240 | 104 | $161.48 | |
| 40 | Twelvestone Medical, INC. | Murfreesboro, TN | 168 | $94.80 |
| 41 | Coram Healthcare Corporation of Florida | Tampa, FL | 279 | $42.64 |
| 42 | Behrens Southern Comfort Medical Supply, LLC | League City, TX | 126 | $3.36 |
| 43 | Founders Healthcare, LLC | Tucson, AZ | 1,137 | $0.00 |
| 44 | Founders Healthcare, LLC | Phoenix, AZ | 771 | $0.00 |