| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
1,455 |
1,253 |
$77K |
| S9366 |
Hit tpn 2 liter diem |
396 |
91 |
$71K |
| S9500 |
Hit antibiotic q24h diem |
543 |
243 |
$62K |
| 99601 |
|
576 |
214 |
$45K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,948 |
3,130 |
$40K |
| S9342 |
Hit enteral pump diem |
2,520 |
2,222 |
$31K |
| S9379 |
Hit noc per diem |
391 |
171 |
$23K |
| S9374 |
Hit hydra 1 liter diem |
270 |
104 |
$22K |
| J1559 |
Hizentra injection |
96 |
27 |
$22K |
| B4035 |
Enteral feed supp pump per d |
326 |
214 |
$22K |
| S9365 |
Hit tpn 1 liter diem |
65 |
14 |
$22K |
| S9501 |
Hit antibiotic q12h diem |
240 |
117 |
$20K |
| J1459 |
Inj ivig privigen 500 mg |
39 |
26 |
$20K |
| S9502 |
Hit antibiotic q8h diem |
255 |
114 |
$19K |
| J0878 |
Daptomycin injection |
130 |
12 |
$19K |
| B4150 |
Ef complet w/intact nutrient |
805 |
627 |
$15K |
| B4152 |
Ef calorie dense>/=1.5kcal |
631 |
444 |
$13K |
| B4153 |
Ef hydrolyzed/amino acids |
176 |
127 |
$10K |
| J3370 |
Vancomycin hcl injection |
119 |
58 |
$9K |
| S9375 |
Hit hydra 2 liter diem |
103 |
36 |
$9K |
| S9338 |
Hit immunotherapy diem |
268 |
134 |
$9K |
| S9367 |
Hit tpn 3 liter diem |
32 |
13 |
$8K |
| J1335 |
Ertapenem injection |
78 |
33 |
$8K |
| A4223 |
Infusion supplies w/o pump |
68 |
34 |
$7K |
| S9343 |
Hit enteral bolus nurs |
658 |
576 |
$7K |
| B4158 |
Ef ped complete intact nut |
349 |
324 |
$7K |
| J0696 |
Ceftriaxone sodium injection |
145 |
71 |
$6K |
| J0692 |
Cefepime hcl for injection |
59 |
25 |
$5K |
| B4149 |
Ef blenderized foods |
291 |
249 |
$5K |
| B4154 |
Ef spec metabolic noninherit |
140 |
122 |
$5K |
| 99602 |
Nursing care in home rn |
92 |
65 |
$4K |
| B4155 |
Ef incomplete/modular |
360 |
335 |
$3K |
| S5498 |
Hit simple cath care |
117 |
36 |
$3K |
| B4034 |
Enter feed supkit syr by day |
66 |
52 |
$3K |
| S9123 |
Nursing care in home rn |
78 |
34 |
$2K |
| S5501 |
Hit complex cath care |
146 |
52 |
$2K |
| G0299 |
Hhs/hospice of rn ea 15 min |
344 |
124 |
$1K |
| B4100 |
Food thickener oral |
168 |
160 |
$1K |
| B4157 |
Ef special metabolic inherit |
15 |
12 |
$1K |
| B4103 |
Ef ped fluid and electrolyte |
283 |
231 |
$1K |
| S9341 |
Hit enteral grav diem |
74 |
74 |
$1K |
| J0690 |
Cefazolin sodium injection |
97 |
36 |
$900.71 |
| S9542 |
Ht inj noc per diem |
782 |
736 |
$765.00 |
| A4221 |
Supp non-insulin inf cath/wk |
113 |
58 |
$564.73 |
| J2997 |
Alteplase recombinant |
13 |
12 |
$525.39 |
| S5502 |
Hit interim cath care |
122 |
94 |
$501.55 |
| B4162 |
Ef ped specmetabolic inherit |
74 |
46 |
$264.36 |
| B4104 |
Additive for enteral formula |
104 |
100 |
$161.48 |
| J2941 |
Somatropin injection |
142 |
141 |
$0.00 |
| J0135 |
Adalimumab injection |
337 |
326 |
$0.00 |
| J1438 |
Etanercept injection |
165 |
160 |
$0.00 |