| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
16,384 |
13,384 |
$3.27M |
| B4161 |
Ef ped hydrolyzed/amino acid |
2,182 |
1,863 |
$1.39M |
| B4035 |
Enteral feed supp pump per d |
4,210 |
3,918 |
$1.19M |
| B4149 |
Ef blenderized foods |
1,819 |
1,456 |
$644K |
| T4534 |
Youth size pull-on |
5,489 |
4,879 |
$640K |
| B4155 |
Ef incomplete/modular |
2,237 |
2,087 |
$545K |
| B9998 |
Enteral supp not otherwise c |
6,193 |
4,832 |
$491K |
| A4554 |
Disposable underpads |
12,762 |
11,921 |
$403K |
| T4532 |
Ped size pull-on lg |
1,681 |
1,470 |
$227K |
| B4150 |
Ef complet w/intact nutrient |
1,163 |
933 |
$213K |
| T4522 |
Adult size brief/diaper med |
1,814 |
1,652 |
$189K |
| T4530 |
Ped size brief/diaper lg |
1,861 |
1,712 |
$174K |
| T4526 |
Adult size pull-on med |
1,215 |
1,103 |
$142K |
| B4034 |
Enter feed supkit syr by day |
911 |
861 |
$139K |
| B4158 |
Ef ped complete intact nut |
663 |
558 |
$123K |
| T4521 |
Adult size brief/diaper sm |
1,243 |
1,066 |
$116K |
| B4152 |
Ef calorie dense>/=1.5kcal |
422 |
367 |
$114K |
| T4525 |
Adult size pull-on sm |
935 |
841 |
$95K |
| A4335 |
Incontinence supply |
16,341 |
15,702 |
$80K |
| B4103 |
Ef ped fluid and electrolyte |
955 |
858 |
$79K |
| B4104 |
Additive for enteral formula |
1,197 |
1,105 |
$64K |
| T4523 |
Adult size brief/diaper lg |
389 |
333 |
$41K |
| A7000 |
Disposable canister for pump |
1,398 |
948 |
$33K |
| A4606 |
Oxygen probe used w oximeter |
337 |
228 |
$25K |
| A4322 |
Irrigation syringe |
614 |
414 |
$19K |
| B4153 |
Ef hydrolyzed/amino acids |
12 |
12 |
$19K |
| A4927 |
Non-sterile gloves |
2,162 |
1,921 |
$13K |
| B9002 |
Enter nutr inf pump any type |
13 |
13 |
$12K |
| A6250 |
Skin seal protect moisturizr |
760 |
738 |
$6K |
| A4628 |
Oropharyngeal suction cath |
954 |
890 |
$5K |
| T4527 |
Adult size pull-on lg |
14 |
12 |
$2K |
| B4100 |
Food thickener oral |
98 |
97 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
117 |
114 |
$119.29 |