| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
19,630 |
15,705 |
$3.78M |
| 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 |
20,835 |
15,594 |
$2.50M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
11,795 |
11,104 |
$2.31M |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
10,677 |
6,369 |
$1.70M |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
11,155 |
7,855 |
$1.07M |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
717 |
635 |
$547K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,627 |
2,297 |
$501K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,492 |
2,321 |
$469K |
| B9998 |
Noc for enteral supplies |
4,848 |
3,702 |
$389K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
3,674 |
2,431 |
$358K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,178 |
2,955 |
$341K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,600 |
1,493 |
$328K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,627 |
1,536 |
$292K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,186 |
2,038 |
$289K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,957 |
1,798 |
$213K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,101 |
1,878 |
$209K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
880 |
842 |
$156K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
1,372 |
1,150 |
$82K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
394 |
358 |
$79K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
272 |
249 |
$78K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,566 |
753 |
$52K |
| B9002 |
Enteral nutrition infusion pump, any type |
527 |
501 |
$40K |
| A4335 |
Incontinence supply; miscellaneous |
1,158 |
1,059 |
$35K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
873 |
807 |
$29K |
| T4541 |
Incontinence product, disposable underpad, large, each |
295 |
281 |
$29K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
51 |
50 |
$14K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
189 |
132 |
$11K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
57 |
56 |
$4K |
| E0776 |
Iv pole |
286 |
277 |
$2K |