| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
3,092 |
2,792 |
$1.35M |
| B4035 |
Enteral feed supp pump per d |
6,975 |
4,102 |
$906K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
5,187 |
4,866 |
$737K |
| B4149 |
Ef blenderized foods |
1,338 |
1,003 |
$333K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,537 |
1,473 |
$147K |
| B4155 |
Ef incomplete/modular |
1,158 |
1,058 |
$143K |
| B4153 |
Ef hydrolyzed/amino acids |
247 |
212 |
$106K |
| B4152 |
Ef calorie dense>/=1.5kcal |
852 |
778 |
$89K |
| B4150 |
Ef complet w/intact nutrient |
855 |
780 |
$86K |
| B4034 |
Enter feed supkit syr by day |
1,045 |
658 |
$70K |
| B4154 |
Ef spec metabolic noninherit |
306 |
284 |
$63K |
| B4103 |
Ef ped fluid and electrolyte |
846 |
773 |
$57K |
| A4554 |
Disposable underpads |
1,238 |
1,189 |
$56K |
| T4534 |
Youth size pull-on |
534 |
509 |
$53K |
| T4530 |
Ped size brief/diaper lg |
569 |
539 |
$45K |
| B9002 |
Enter nutr inf pump any type |
1,249 |
806 |
$27K |
| B4100 |
Food thickener oral |
328 |
299 |
$26K |
| T4522 |
Adult size brief/diaper med |
245 |
231 |
$25K |
| B4158 |
Ef ped complete intact nut |
140 |
122 |
$16K |
| T4532 |
Ped size pull-on lg |
158 |
149 |
$16K |
| A9999 |
Dme supply or accessory, nos |
116 |
113 |
$13K |
| A4335 |
Incontinence supply |
1,703 |
1,639 |
$11K |
| B4036 |
Enteral feed sup kit grav by |
60 |
37 |
$7K |
| B4104 |
Additive for enteral formula |
147 |
143 |
$6K |
| E0776 |
Iv pole |
803 |
537 |
$6K |
| A4927 |
Non-sterile gloves |
307 |
282 |
$5K |
| B9998 |
Enteral supp not otherwise c |
748 |
699 |
$4K |
| W4211 |
|
261 |
247 |
$19.26 |