| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,900 |
1,042 |
$721K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,704 |
3,240 |
$626K |
| 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 |
4,883 |
2,650 |
$555K |
| 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 |
1,352 |
1,048 |
$164K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,735 |
1,449 |
$153K |
| 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 |
1,127 |
867 |
$151K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,494 |
1,288 |
$148K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,269 |
1,133 |
$98K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
813 |
693 |
$98K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,000 |
858 |
$91K |
| B9998 |
Noc for enteral supplies |
569 |
330 |
$87K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,606 |
2,262 |
$85K |
| B4100 |
Food thickener, administered orally, per ounce |
525 |
449 |
$58K |
| 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 |
1,141 |
929 |
$55K |
| 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 |
88 |
76 |
$55K |
| 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 |
347 |
162 |
$54K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
509 |
423 |
$45K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
491 |
440 |
$39K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
297 |
219 |
$23K |
| A4927 |
Gloves, non-sterile, per 100 |
2,016 |
1,716 |
$16K |
| A7000 |
Canister, disposable, used with suction pump, each |
819 |
731 |
$15K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
800 |
629 |
$6K |
| B9002 |
Enteral nutrition infusion pump, any type |
48 |
45 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13 |
12 |
$1K |
| A4402 |
Lubricant, per ounce |
188 |
174 |
$326.84 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
47 |
26 |
$64.50 |