| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
27,902 |
26,278 |
$6.68M |
| B4161 |
Ef ped hydrolyzed/amino acid |
12,885 |
11,839 |
$6.44M |
| B4149 |
Ef blenderized foods |
14,618 |
13,407 |
$5.04M |
| B4087 |
Gastro/jejuno tube, std |
23,337 |
22,189 |
$2.87M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
20,435 |
19,425 |
$2.26M |
| B4153 |
Ef hydrolyzed/amino acids |
2,773 |
2,400 |
$1.22M |
| B4034 |
Enter feed supkit syr by day |
7,524 |
6,958 |
$915K |
| B4152 |
Ef calorie dense>/=1.5kcal |
5,409 |
4,985 |
$892K |
| B4150 |
Ef complet w/intact nutrient |
5,898 |
5,280 |
$767K |
| B9002 |
Enter nutr inf pump any type |
6,892 |
6,482 |
$575K |
| B4088 |
Gastro/jejuno tube, low-pro |
9,025 |
8,735 |
$559K |
| S9999 |
Sales tax |
35,644 |
21,509 |
$446K |
| B4158 |
Ef ped complete intact nut |
3,609 |
3,307 |
$418K |
| T4530 |
Ped size brief/diaper lg |
6,018 |
5,645 |
$406K |
| B4154 |
Ef spec metabolic noninherit |
1,620 |
1,427 |
$339K |
| B4155 |
Ef incomplete/modular |
5,706 |
5,324 |
$272K |
| B9998 |
Enteral supp not otherwise c |
1,340 |
1,153 |
$243K |
| T4534 |
Youth size pull-on |
2,496 |
2,436 |
$233K |
| T4541 |
Large disposable underpad |
5,590 |
5,355 |
$192K |
| T4537 |
Reusable underpad bed size |
5,442 |
5,305 |
$190K |
| B4036 |
Enteral feed sup kit grav by |
1,103 |
1,028 |
$167K |
| T4522 |
Adult size brief/diaper med |
2,109 |
2,017 |
$164K |
| T4523 |
Adult size brief/diaper lg |
1,635 |
1,552 |
$158K |
| A4927 |
Non-sterile gloves |
12,441 |
11,788 |
$140K |
| B4100 |
Food thickener oral |
2,607 |
2,478 |
$113K |
| T4524 |
Adult size brief/diaper xl |
908 |
850 |
$95K |
| B4103 |
Ef ped fluid and electrolyte |
2,108 |
1,988 |
$88K |
| E0776 |
Iv pole |
4,352 |
4,239 |
$79K |
| A4351 |
Straight tip urine catheter |
580 |
543 |
$78K |
| T4535 |
Disposable liner/shield/pad |
2,239 |
2,147 |
$72K |
| B4081 |
Enteral ng tubing w/ stylet |
1,589 |
1,158 |
$59K |
| T4526 |
Adult size pull-on med |
597 |
583 |
$55K |
| T4525 |
Adult size pull-on sm |
461 |
434 |
$43K |
| T4532 |
Ped size pull-on lg |
548 |
533 |
$42K |
| A6218 |
Non-sterile gauze > 48 sq in |
189 |
164 |
$33K |
| T4533 |
Youth size brief/diaper |
475 |
458 |
$32K |
| B4162 |
Ef ped specmetabolic inherit |
52 |
48 |
$21K |
| B4082 |
Enteral ng tubing w/o stylet |
377 |
358 |
$14K |
| A4357 |
Bedside drainage bag |
287 |
260 |
$6K |
| T4531 |
Ped size pull-on sm/med |
68 |
66 |
$4K |
| A4335 |
Incontinence supply |
407 |
401 |
$3K |
| A4628 |
Oropharyngeal suction cath |
180 |
166 |
$2K |
| A4332 |
Lube sterile packet |
126 |
121 |
$1K |
| A7000 |
Disposable canister for pump |
16 |
13 |
$339.68 |
| A7002 |
Tubing used w suction pump |
12 |
12 |
$183.64 |
| A6260 |
Wound cleanser any type/size |
13 |
12 |
$23.12 |