| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
4,719 |
4,143 |
$3.54M |
| B4035 |
Enteral feed supp pump per d |
16,943 |
11,171 |
$2.73M |
| B4149 |
Ef blenderized foods |
5,793 |
4,985 |
$2.14M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,939 |
3,480 |
$942K |
| B4088 |
Gastro/jejuno tube, low-pro |
4,980 |
4,810 |
$811K |
| A4223 |
Infusion supplies w/o pump |
27,834 |
3,655 |
$546K |
| B4034 |
Enter feed supkit syr by day |
5,858 |
3,471 |
$428K |
| B4162 |
Ef ped specmetabolic inherit |
473 |
446 |
$235K |
| A4222 |
Infusion supplies with pump |
3,456 |
1,746 |
$229K |
| A4221 |
Supp non-insulin inf cath/wk |
8,505 |
4,713 |
$201K |
| B4158 |
Ef ped complete intact nut |
731 |
615 |
$184K |
| B4155 |
Ef incomplete/modular |
653 |
568 |
$45K |
| B9002 |
Enter nutr inf pump any type |
254 |
253 |
$39K |
| B4224 |
Parenteral administration ki |
324 |
74 |
$37K |
| E0776 |
Iv pole |
156 |
156 |
$25K |
| A4305 |
Drug delivery system >=50 ml |
86 |
41 |
$13K |
| B4220 |
Parenteral supply kit premix |
323 |
74 |
$12K |
| A4306 |
Drug delivery system <=50 ml |
61 |
25 |
$6K |
| B4152 |
Ef calorie dense>/=1.5kcal |
13 |
12 |
$2K |
| A4353 |
Intermittent urinary cath |
18 |
17 |
$92.70 |