| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4105 |
Enzyme cartridge enteral nut |
225 |
186 |
$880K |
| B4185 |
Pn soln nos 10 grams lipids |
1,916 |
464 |
$482K |
| S9500 |
Hit antibiotic q24h diem |
7,039 |
542 |
$327K |
| B4035 |
Enteral feed supp pump per d |
2,558 |
977 |
$78K |
| A4222 |
Infusion supplies with pump |
787 |
202 |
$54K |
| 99601 |
|
311 |
94 |
$36K |
| B4152 |
Ef calorie dense>/=1.5kcal |
507 |
454 |
$25K |
| B4150 |
Ef complet w/intact nutrient |
464 |
427 |
$21K |
| B4224 |
Parenteral administration ki |
255 |
40 |
$19K |
| B4034 |
Enter feed supkit syr by day |
1,274 |
652 |
$19K |
| S9379 |
Hit noc per diem |
143 |
37 |
$8K |
| B4220 |
Parenteral supply kit premix |
255 |
40 |
$6K |
| A4223 |
Infusion supplies w/o pump |
820 |
151 |
$5K |
| A4221 |
Supp non-insulin inf cath/wk |
662 |
333 |
$3K |
| A4245 |
Alcohol wipes per box |
440 |
271 |
$545.92 |
| A4216 |
Sterile water/saline, 10 ml |
65 |
40 |
$410.55 |
| S1015 |
Iv tubing extension set |
21 |
15 |
$302.92 |
| A5200 |
Percutaneous catheter anchor |
18 |
13 |
$78.80 |