| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,098 |
1,016 |
$752K |
| B9998 |
Noc for enteral supplies |
2,148 |
1,174 |
$579K |
| 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 |
1,141 |
1,034 |
$290K |
| S9434 |
Modified solid food supplements for inborn errors of metabolism |
375 |
257 |
$197K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
798 |
688 |
$169K |
| 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 |
770 |
661 |
$93K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
738 |
691 |
$63K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
718 |
645 |
$63K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,093 |
749 |
$46K |
| A4927 |
Gloves, non-sterile, per 100 |
2,157 |
1,745 |
$40K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
378 |
348 |
$40K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,668 |
1,543 |
$37K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,110 |
967 |
$34K |
| T5999 |
Supply, not otherwise specified |
135 |
110 |
$28K |
| B4100 |
Food thickener, administered orally, per ounce |
180 |
169 |
$25K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,801 |
1,007 |
$20K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
175 |
155 |
$18K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
142 |
136 |
$17K |
| E2510 |
Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access |
16 |
12 |
$17K |
| B9002 |
Enteral nutrition infusion pump, any type |
147 |
142 |
$15K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
13 |
12 |
$10K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
47 |
41 |
$4K |
| E1399 |
Durable medical equipment, miscellaneous |
22 |
12 |
$4K |
| K0001 |
Standard wheelchair |
124 |
99 |
$3K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
215 |
141 |
$3K |
| A4335 |
Incontinence supply; miscellaneous |
236 |
186 |
$3K |
| K0003 |
Lightweight wheelchair |
81 |
62 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
13 |
13 |
$1K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
173 |
82 |
$683.29 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
21 |
12 |
$360.12 |
| A5120 |
Skin barrier, wipes or swabs, each |
36 |
27 |
$165.41 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
30 |
24 |
$32.44 |