| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,172 |
1,103 |
$232K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,019 |
979 |
$139K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
896 |
830 |
$122K |
| 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 |
1,228 |
1,123 |
$112K |
| 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 |
1,004 |
960 |
$74K |
| E0570 |
Nebulizer, with compressor |
1,880 |
1,782 |
$70K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,846 |
1,731 |
$69K |
| 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 |
889 |
854 |
$64K |
| A4670 |
Automatic blood pressure monitor |
989 |
931 |
$32K |
| A4927 |
Gloves, non-sterile, per 100 |
1,876 |
1,730 |
$14K |
| A4554 |
Disposable underpads, all sizes |
332 |
311 |
$8K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
14 |
14 |
$4K |
| A7016 |
Dome and mouthpiece, used with small volume ultrasonic nebulizer |
927 |
893 |
$3K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
26 |
26 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
12 |
12 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
745 |
724 |
$688.75 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
14 |
14 |
$642.60 |
| E0605 |
Vaporizer, room type |
12 |
12 |
$155.37 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
502 |
498 |
$14.85 |
| G0008 |
Administration of influenza virus vaccine |
16 |
16 |
$0.00 |
| J7626 |
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg |
38 |
37 |
$0.00 |
| J7605 |
Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms |
42 |
38 |
$0.00 |
| 90688 |
|
15 |
15 |
$0.00 |