| 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 |
520 |
484 |
$74K |
| 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 |
529 |
497 |
$54K |
| T4541 |
Incontinence product, disposable underpad, large, each |
623 |
591 |
$22K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
3,958 |
3,780 |
$17K |
| 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 |
42 |
40 |
$4K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
62 |
61 |
$2K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
343 |
275 |
$2K |
| E0570 |
Nebulizer, with compressor |
96 |
93 |
$1K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
28 |
27 |
$1K |
| A4670 |
Automatic blood pressure monitor |
24 |
24 |
$665.00 |
| A7015 |
Aerosol mask, used with dme nebulizer |
12 |
12 |
$42.50 |