| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
9,973 |
1,470 |
$57K |
| S1015 |
Iv tubing extension set |
2,474 |
970 |
$7K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
213 |
70 |
$6K |
| 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 |
256 |
143 |
$4K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
42 |
24 |
$788.32 |
| 99601 |
|
22 |
15 |
$325.60 |