| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,272 |
4,134 |
$1.04M |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
4,826 |
4,697 |
$613K |
| 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 |
2,010 |
1,948 |
$369K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,236 |
1,214 |
$205K |
| 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 |
375 |
362 |
$122K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
1,281 |
1,223 |
$113K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
131 |
129 |
$93K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
326 |
320 |
$55K |
| 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 |
86 |
86 |
$35K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
326 |
298 |
$30K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
29 |
25 |
$23K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
101 |
97 |
$17K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
550 |
534 |
$16K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
27 |
25 |
$2K |