| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
2,787 |
1,121 |
$2.17M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,705 |
5,188 |
$1.10M |
| 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 |
3,444 |
3,019 |
$449K |
| 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 |
914 |
764 |
$425K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
2,791 |
1,649 |
$292K |
| 99601 |
|
1,995 |
1,091 |
$238K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,742 |
2,109 |
$236K |
| 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 |
1,978 |
1,699 |
$223K |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
64 |
64 |
$169K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
5,537 |
3,137 |
$119K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
767 |
758 |
$59K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
188 |
48 |
$58K |
| B9002 |
Enteral nutrition infusion pump, any type |
434 |
417 |
$34K |
| 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 |
62 |
50 |
$8K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
39 |
36 |
$4K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
206 |
65 |
$1K |