| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2357 |
Injection, omalizumab, 5 mg |
3,421 |
3,009 |
$10.07M |
| J2426 |
Injection, paliperidone palmitate extended release (invega sustenna), 1 mg |
2,439 |
2,150 |
$6.53M |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
15,806 |
9,469 |
$5.55M |
| J1726 |
Injection, hydroxyprogesterone caproate, (makena), 10 mg |
1,220 |
1,050 |
$3.60M |
| 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 |
16,965 |
10,995 |
$2.09M |
| 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 |
4,238 |
2,885 |
$1.74M |
| J1950 |
Injection, leuprolide acetate (for depot suspension), per 3.75 mg |
348 |
330 |
$1.45M |
| S9343 |
Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
3,511 |
2,322 |
$1.01M |
| J0401 |
Injection, aripiprazole (abilify maintena), 1 mg |
488 |
438 |
$988K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
771 |
720 |
$937K |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
999 |
798 |
$877K |
| J2794 |
Injection, risperidone (risperdal consta), 0.5 mg |
415 |
344 |
$626K |
| 90378 |
|
144 |
126 |
$548K |
| 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 |
2,433 |
1,567 |
$465K |
| 99601 |
|
4,903 |
1,361 |
$457K |
| J3490 |
Unclassified drugs |
224 |
165 |
$417K |
| 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 |
5,038 |
3,344 |
$320K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,854 |
2,031 |
$210K |
| 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 |
1,025 |
774 |
$194K |
| 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 |
3,243 |
2,014 |
$160K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,242 |
1,056 |
$94K |
| J1725 |
Injection, hydroxyprogesterone caproate, 1 mg |
33 |
33 |
$93K |
| 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 |
2,552 |
1,694 |
$71K |
| S9500 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
267 |
98 |
$65K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
150 |
102 |
$31K |
| 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 |
230 |
161 |
$23K |
| S9340 |
Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
55 |
52 |
$19K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,653 |
1,032 |
$18K |
| J7325 |
Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg |
17 |
17 |
$8K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
50 |
40 |
$7K |
| S9502 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
23 |
12 |
$7K |
| B9998 |
Noc for enteral supplies |
203 |
83 |
$3K |
| B9002 |
Enteral nutrition infusion pump, any type |
31 |
12 |
$87.82 |