| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,079 |
1,617 |
$71K |
| 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 |
1,423 |
1,107 |
$71K |
| 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 |
955 |
781 |
$60K |
| T4541 |
Incontinence product, disposable underpad, large, each |
957 |
792 |
$33K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
802 |
605 |
$16K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
146 |
127 |
$14K |
| A4927 |
Gloves, non-sterile, per 100 |
934 |
765 |
$7K |
| 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 |
32 |
24 |
$2K |
| E0776 |
Iv pole |
928 |
888 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
55 |
51 |
$61.20 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
55 |
51 |
$23.18 |