| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2357 |
Omalizumab injection |
3,421 |
3,009 |
$10.07M |
| J2426 |
Inj, invega sustenna, 1 mg |
2,439 |
2,150 |
$6.53M |
| S9342 |
Hit enteral pump diem |
15,806 |
9,469 |
$5.55M |
| J1726 |
Makena, 10 mg |
1,220 |
1,050 |
$3.60M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
16,965 |
10,995 |
$2.09M |
| B4161 |
Ef ped hydrolyzed/amino acid |
4,238 |
2,885 |
$1.74M |
| J1950 |
Leuprolide acetate /3.75 mg |
348 |
330 |
$1.45M |
| S9343 |
Hit enteral bolus nurs |
3,511 |
2,322 |
$1.01M |
| J0401 |
Inj, abilify maintena, 1 mg |
488 |
438 |
$988K |
| J2315 |
Naltrexone, depot form |
771 |
720 |
$937K |
| J0585 |
Injection,onabotulinumtoxina |
999 |
798 |
$877K |
| J2794 |
Inj risperdal consta, 0.5 mg |
415 |
344 |
$626K |
| 90378 |
|
144 |
126 |
$548K |
| B4149 |
Ef blenderized foods |
2,433 |
1,567 |
$465K |
| 99601 |
|
4,903 |
1,361 |
$457K |
| J3490 |
Drugs unclassified injection |
224 |
165 |
$417K |
| B4152 |
Ef calorie dense>/=1.5kcal |
5,038 |
3,344 |
$320K |
| B4035 |
Enteral feed supp pump per d |
3,854 |
2,031 |
$210K |
| B4158 |
Ef ped complete intact nut |
1,025 |
774 |
$194K |
| B4150 |
Ef complet w/intact nutrient |
3,243 |
2,014 |
$160K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,242 |
1,056 |
$94K |
| J1725 |
Hydroxyprogesterone caproate |
33 |
33 |
$93K |
| B4155 |
Ef incomplete/modular |
2,552 |
1,694 |
$71K |
| S9500 |
Hit antibiotic q24h diem |
267 |
98 |
$65K |
| B4153 |
Ef hydrolyzed/amino acids |
150 |
102 |
$31K |
| B4154 |
Ef spec metabolic noninherit |
230 |
161 |
$23K |
| S9340 |
Hit enteral per diem |
55 |
52 |
$19K |
| B4034 |
Enter feed supkit syr by day |
1,653 |
1,032 |
$18K |
| J7325 |
Synvisc or synvisc-one |
17 |
17 |
$8K |
| B4102 |
Ef adult fluids and electro |
50 |
40 |
$7K |
| S9502 |
Hit antibiotic q8h diem |
23 |
12 |
$7K |
| B9998 |
Enteral supp not otherwise c |
203 |
83 |
$3K |
| B9002 |
Enter nutr inf pump any type |
31 |
12 |
$87.82 |