| 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 |
8,014 |
6,631 |
$3.52M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
9,258 |
8,219 |
$2.63M |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
8,364 |
7,717 |
$1.34M |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
5,765 |
4,131 |
$1.25M |
| 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 |
6,428 |
5,152 |
$656K |
| B9002 |
Enteral nutrition infusion pump, any type |
5,477 |
5,199 |
$576K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,651 |
2,618 |
$247K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,057 |
999 |
$158K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
394 |
149 |
$142K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
1,932 |
1,691 |
$102K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
417 |
391 |
$92K |
| B4100 |
Food thickener, administered orally, per ounce |
2,031 |
1,684 |
$90K |
| 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 |
697 |
583 |
$79K |
| 99601 |
|
664 |
334 |
$79K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
711 |
552 |
$64K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
1,262 |
599 |
$35K |
| B4081 |
Nasogastric tubing with stylet |
530 |
474 |
$24K |
| 90378 |
|
16 |
12 |
$20K |
| 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 |
143 |
109 |
$14K |
| E0776 |
Iv pole |
462 |
453 |
$12K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
259 |
234 |
$9K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
13 |
12 |
$968.36 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
19 |
17 |
$60.27 |