| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
5,051 |
4,259 |
$5.13M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
8,241 |
7,285 |
$3.15M |
| B4035 |
Enteral feed supp pump per d |
13,487 |
11,703 |
$2.87M |
| B4149 |
Ef blenderized foods |
5,329 |
4,496 |
$1.77M |
| B4034 |
Enter feed supkit syr by day |
4,501 |
3,922 |
$547K |
| B4088 |
Gastro/jejuno tube, low-pro |
4,794 |
4,241 |
$400K |
| T4530 |
Ped size brief/diaper lg |
3,211 |
2,770 |
$178K |
| T4534 |
Youth size pull-on |
3,130 |
2,649 |
$177K |
| T4522 |
Adult size brief/diaper med |
2,415 |
2,058 |
$163K |
| T4541 |
Large disposable underpad |
4,940 |
4,364 |
$130K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,002 |
710 |
$116K |
| B9002 |
Enter nutr inf pump any type |
2,063 |
1,754 |
$113K |
| B4153 |
Ef hydrolyzed/amino acids |
140 |
111 |
$78K |
| B4150 |
Ef complet w/intact nutrient |
619 |
471 |
$60K |
| T4523 |
Adult size brief/diaper lg |
633 |
537 |
$55K |
| B9998 |
Enteral supp not otherwise c |
935 |
787 |
$44K |
| E0776 |
Iv pole |
2,238 |
2,015 |
$24K |
| B4103 |
Ef ped fluid and electrolyte |
1,497 |
929 |
$21K |
| B4155 |
Ef incomplete/modular |
642 |
550 |
$17K |
| T4521 |
Adult size brief/diaper sm |
220 |
198 |
$14K |
| B4158 |
Ef ped complete intact nut |
66 |
50 |
$11K |
| T4526 |
Adult size pull-on med |
42 |
29 |
$2K |
| B4087 |
Gastro/jejuno tube, std |
37 |
26 |
$1K |
| T4535 |
Disposable liner/shield/pad |
16 |
12 |
$213.49 |
| A4554 |
Disposable underpads |
15 |
13 |
$0.00 |