| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4222 |
Infusion supplies with pump |
4,890 |
1,745 |
$789K |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,245 |
922 |
$745K |
| B4035 |
Enteral feed supp pump per d |
4,295 |
3,109 |
$638K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,827 |
1,499 |
$501K |
| B9998 |
Enteral supp not otherwise c |
5,594 |
2,841 |
$421K |
| A4305 |
Drug delivery system >=50 ml |
1,379 |
474 |
$287K |
| B4034 |
Enter feed supkit syr by day |
2,997 |
2,405 |
$239K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,657 |
1,875 |
$174K |
| B4150 |
Ef complet w/intact nutrient |
2,313 |
1,547 |
$140K |
| B4149 |
Ef blenderized foods |
191 |
154 |
$72K |
| A4221 |
Supp non-insulin inf cath/wk |
5,464 |
1,964 |
$56K |
| E1390 |
Oxygen concentrator |
898 |
788 |
$9K |
| B9002 |
Enter nutr inf pump any type |
72 |
65 |
$3K |
| J9190 |
Fluorouracil injection |
207 |
85 |
$1K |
| B4100 |
Food thickener oral |
15 |
12 |
$571.72 |
| E0431 |
Portable gaseous 02 |
215 |
168 |
$528.83 |
| B4088 |
Gastro/jejuno tube, low-pro |
13 |
13 |
$288.12 |
| 90662 |
|
36 |
22 |
$0.00 |
| 0013A |
|
219 |
219 |
$0.00 |
| 91320 |
|
280 |
256 |
$0.00 |
| 0003A |
|
58 |
58 |
$0.00 |
| 91304 |
|
66 |
66 |
$0.00 |
| 888888 |
|
19 |
19 |
$0.00 |
| 91322 |
|
267 |
265 |
$0.00 |
| 0124A |
|
58 |
58 |
$0.00 |
| 90686 |
|
102 |
102 |
$0.00 |
| A9270 |
Non-covered item or service |
760 |
312 |
$0.00 |
| 0134A |
|
77 |
77 |
$0.00 |
| 90656 |
|
18 |
18 |
$0.00 |
| G0008 |
Admin influenza virus vac |
140 |
126 |
$0.00 |
| 90480 |
|
594 |
568 |
$0.00 |
| Q0513 |
Disp fee inhal drugs/30 days |
13 |
13 |
$0.00 |
| 90677 |
|
18 |
18 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
23 |
23 |
$0.00 |
| 0064A |
|
82 |
82 |
$0.00 |