| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
4,890 |
1,745 |
$789K |
| 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 |
1,245 |
922 |
$745K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,295 |
3,109 |
$638K |
| 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 |
1,827 |
1,499 |
$501K |
| B9998 |
Noc for enteral supplies |
5,594 |
2,841 |
$421K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
1,379 |
474 |
$287K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,997 |
2,405 |
$239K |
| 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 |
2,657 |
1,875 |
$174K |
| 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 |
2,313 |
1,547 |
$140K |
| 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 |
191 |
154 |
$72K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
5,464 |
1,964 |
$56K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
898 |
788 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
72 |
65 |
$3K |
| J9190 |
Injection, fluorouracil, 500 mg |
207 |
85 |
$1K |
| B4100 |
Food thickener, administered orally, per ounce |
15 |
12 |
$571.72 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
215 |
168 |
$528.83 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
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 |
Administration of influenza virus vaccine |
140 |
126 |
$0.00 |
| 90480 |
|
594 |
568 |
$0.00 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
13 |
13 |
$0.00 |
| 90677 |
|
18 |
18 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
23 |
23 |
$0.00 |
| 0064A |
|
82 |
82 |
$0.00 |