| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0776 |
Iv pole |
4,274 |
3,610 |
$20K |
| 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 |
3,281 |
2,750 |
$20K |
| 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 |
1,512 |
1,208 |
$18K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,464 |
3,785 |
$13K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,069 |
1,700 |
$6K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
4,111 |
3,355 |
$3K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
418 |
340 |
$1K |
| 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 |
156 |
140 |
$1K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
107 |
78 |
$758.79 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
4,643 |
3,654 |
$534.10 |
| A4623 |
Tracheostomy, inner cannula |
21 |
12 |
$107.40 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
20 |
12 |
$76.20 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
47 |
27 |
$0.00 |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
29 |
24 |
$0.00 |