| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1559 |
Hizentra injection |
1,885 |
839 |
$1.96M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,515 |
956 |
$644K |
| B4035 |
Enteral feed supp pump per d |
4,742 |
3,934 |
$609K |
| B4153 |
Ef hydrolyzed/amino acids |
1,096 |
789 |
$518K |
| A4223 |
Infusion supplies w/o pump |
3,553 |
1,434 |
$386K |
| B4149 |
Ef blenderized foods |
1,372 |
989 |
$352K |
| 99601 |
|
3,640 |
1,207 |
$326K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,374 |
1,262 |
$308K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,296 |
1,419 |
$236K |
| B4150 |
Ef complet w/intact nutrient |
1,862 |
1,308 |
$203K |
| A4222 |
Infusion supplies with pump |
1,247 |
581 |
$141K |
| B9998 |
Enteral supp not otherwise c |
1,366 |
1,231 |
$116K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,242 |
1,164 |
$116K |
| A4221 |
Supp non-insulin inf cath/wk |
6,693 |
3,181 |
$114K |
| B9002 |
Enter nutr inf pump any type |
1,569 |
1,488 |
$81K |
| 99602 |
Nursing care in home rn |
557 |
281 |
$56K |
| B4034 |
Enter feed supkit syr by day |
687 |
593 |
$40K |
| B4155 |
Ef incomplete/modular |
592 |
477 |
$30K |
| J3490 |
Drugs unclassified injection |
113 |
25 |
$12K |
| S9500 |
Hit antibiotic q24h diem |
117 |
13 |
$8K |
| K0552 |
Sup/ext non-ins inf pump syr |
2,416 |
1,184 |
$7K |
| B4100 |
Food thickener oral |
92 |
75 |
$3K |
| B4036 |
Enteral feed sup kit grav by |
17 |
12 |
$2K |
| B4185 |
Pn soln nos 10 grams lipids |
39 |
12 |
$1K |
| E0781 |
External ambulatory infus pu |
399 |
91 |
$1K |
| J7050 |
Normal saline solution infus |
22 |
13 |
$77.00 |
| A4209 |
5+ cc sterile syringe&needle |
58 |
24 |
$49.35 |