| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
1,900 |
1,042 |
$721K |
| B4035 |
Enteral feed supp pump per d |
3,704 |
3,240 |
$626K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,883 |
2,650 |
$555K |
| B4150 |
Ef complet w/intact nutrient |
1,352 |
1,048 |
$164K |
| B4034 |
Enter feed supkit syr by day |
1,735 |
1,449 |
$153K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,127 |
867 |
$151K |
| T4522 |
Adult size brief/diaper med |
1,494 |
1,288 |
$148K |
| T4534 |
Youth size pull-on |
1,269 |
1,133 |
$98K |
| T4527 |
Adult size pull-on lg |
813 |
693 |
$98K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,000 |
858 |
$91K |
| B9998 |
Enteral supp not otherwise c |
569 |
330 |
$87K |
| T4541 |
Large disposable underpad |
2,606 |
2,262 |
$85K |
| B4100 |
Food thickener oral |
525 |
449 |
$58K |
| B4155 |
Ef incomplete/modular |
1,141 |
929 |
$55K |
| B4153 |
Ef hydrolyzed/amino acids |
88 |
76 |
$55K |
| B4149 |
Ef blenderized foods |
347 |
162 |
$54K |
| T4533 |
Youth size brief/diaper |
509 |
423 |
$45K |
| T4530 |
Ped size brief/diaper lg |
491 |
440 |
$39K |
| T4525 |
Adult size pull-on sm |
297 |
219 |
$23K |
| A4927 |
Non-sterile gloves |
2,016 |
1,716 |
$16K |
| A7000 |
Disposable canister for pump |
819 |
731 |
$15K |
| A4628 |
Oropharyngeal suction cath |
800 |
629 |
$6K |
| B9002 |
Enter nutr inf pump any type |
48 |
45 |
$2K |
| T4523 |
Adult size brief/diaper lg |
13 |
12 |
$1K |
| A4402 |
Lubricant per ounce |
188 |
174 |
$326.84 |
| A7003 |
Nebulizer administration set |
47 |
26 |
$64.50 |