| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
16,384 |
13,384 |
$3.27M |
| 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 |
2,182 |
1,863 |
$1.39M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,210 |
3,918 |
$1.19M |
| 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 |
1,819 |
1,456 |
$644K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,489 |
4,879 |
$640K |
| 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 |
2,237 |
2,087 |
$545K |
| B9998 |
Noc for enteral supplies |
6,193 |
4,832 |
$491K |
| A4554 |
Disposable underpads, all sizes |
12,762 |
11,921 |
$403K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,681 |
1,470 |
$227K |
| 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 |
1,163 |
933 |
$213K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,814 |
1,652 |
$189K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,861 |
1,712 |
$174K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,215 |
1,103 |
$142K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
911 |
861 |
$139K |
| 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 |
663 |
558 |
$123K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,243 |
1,066 |
$116K |
| 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 |
422 |
367 |
$114K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
935 |
841 |
$95K |
| A4335 |
Incontinence supply; miscellaneous |
16,341 |
15,702 |
$80K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
955 |
858 |
$79K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
1,197 |
1,105 |
$64K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
389 |
333 |
$41K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,398 |
948 |
$33K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
337 |
228 |
$25K |
| A4322 |
Irrigation syringe, bulb or piston, each |
614 |
414 |
$19K |
| 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 |
12 |
12 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
2,162 |
1,921 |
$13K |
| B9002 |
Enteral nutrition infusion pump, any type |
13 |
13 |
$12K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
760 |
738 |
$6K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
954 |
890 |
$5K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
14 |
12 |
$2K |
| B4100 |
Food thickener, administered orally, per ounce |
98 |
97 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
117 |
114 |
$119.29 |