| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7170 |
Injection, emicizumab-kxwh, 0.5 mg |
214 |
168 |
$7.29M |
| 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 |
10,156 |
4,538 |
$2.28M |
| 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 |
27,644 |
14,487 |
$2.10M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
28,634 |
10,108 |
$1.88M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
10,439 |
9,695 |
$897K |
| 90378 |
|
318 |
212 |
$796K |
| B9998 |
Noc for enteral supplies |
24,159 |
7,974 |
$737K |
| 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 |
4,378 |
1,782 |
$729K |
| 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 |
7,456 |
3,314 |
$510K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,815 |
2,632 |
$494K |
| 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 |
2,813 |
605 |
$439K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,434 |
4,900 |
$436K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12,143 |
4,462 |
$429K |
| 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 |
6,217 |
3,060 |
$367K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,640 |
3,186 |
$344K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,552 |
2,338 |
$284K |
| 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 |
6,917 |
2,934 |
$248K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,084 |
2,495 |
$221K |
| J3490 |
Unclassified drugs |
3,934 |
137 |
$221K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,124 |
5,699 |
$197K |
| B4100 |
Food thickener, administered orally, per ounce |
4,767 |
2,243 |
$172K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,241 |
502 |
$170K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,335 |
1,223 |
$158K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
3,079 |
1,782 |
$121K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
533 |
480 |
$107K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,062 |
946 |
$103K |
| E0570 |
Nebulizer, with compressor |
846 |
784 |
$94K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
668 |
631 |
$64K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
469 |
423 |
$60K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
569 |
553 |
$46K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
326 |
105 |
$42K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,237 |
1,987 |
$39K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
654 |
510 |
$37K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
1,260 |
540 |
$30K |
| A4670 |
Automatic blood pressure monitor |
646 |
599 |
$27K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
3,080 |
2,246 |
$25K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,190 |
1,875 |
$17K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
87 |
39 |
$17K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
379 |
351 |
$16K |
| K0001 |
Standard wheelchair |
341 |
308 |
$15K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
622 |
540 |
$13K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
127 |
125 |
$12K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,996 |
2,683 |
$10K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
652 |
169 |
$10K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
910 |
663 |
$8K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
120 |
111 |
$8K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
312 |
290 |
$7K |
| 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 |
70 |
40 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,017 |
2,614 |
$5K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
21 |
14 |
$4K |
| B4082 |
Nasogastric tubing without stylet |
171 |
146 |
$4K |
| A4402 |
Lubricant, per ounce |
1,458 |
1,342 |
$3K |
| A6237 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
214 |
202 |
$3K |
| B4081 |
Nasogastric tubing with stylet |
128 |
101 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
118 |
92 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
25 |
25 |
$1K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
27 |
27 |
$1K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
16 |
12 |
$995.66 |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14 |
13 |
$564.44 |
| E0155 |
Wheel attachment, rigid pick-up walker, per pair |
44 |
41 |
$555.20 |
| A4398 |
Ostomy irrigation supply; bag, each |
140 |
107 |
$550.57 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
78 |
67 |
$494.67 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
336 |
303 |
$342.88 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
107 |
96 |
$262.15 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
32 |
25 |
$182.36 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
45 |
44 |
$106.72 |
| A5120 |
Skin barrier, wipes or swabs, each |
107 |
89 |
$98.99 |
| A4663 |
Blood pressure cuff only |
12 |
12 |
$0.00 |