| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,004 |
1,705 |
$418K |
| 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 |
2,160 |
1,950 |
$316K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,455 |
3,860 |
$217K |
| 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 |
237 |
176 |
$81K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
384 |
354 |
$25K |
| E0776 |
Iv pole |
2,214 |
2,139 |
$20K |
| A6233 |
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing |
82 |
58 |
$13K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
288 |
252 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
582 |
501 |
$7K |
| B9002 |
Enteral nutrition infusion pump, any type |
26 |
25 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
113 |
113 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
299 |
252 |
$1K |