| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,731 |
1,603 |
$775K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,408 |
3,092 |
$522K |
| 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 |
769 |
667 |
$355K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
12,866 |
2,656 |
$343K |
| 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 |
2,240 |
1,572 |
$305K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
467 |
299 |
$15K |
| 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 |
31 |
25 |
$6K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
310 |
64 |
$4K |
| B9002 |
Enteral nutrition infusion pump, any type |
30 |
24 |
$3K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
2,659 |
195 |
$2K |
| S5170 |
Home delivered meals, including preparation; per meal |
50 |
37 |
$533.68 |
| S1015 |
Iv tubing extension set |
22 |
13 |
$98.94 |