| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7170 |
Injection, emicizumab-kxwh, 0.5 mg |
164 |
125 |
$4.95M |
| 90378 |
|
1,299 |
815 |
$3.15M |
| 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 |
13,847 |
8,994 |
$1.29M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,186 |
6,322 |
$1.28M |
| 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 |
3,568 |
2,684 |
$1.11M |
| G0299 |
Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
12,801 |
5,881 |
$537K |
| G0151 |
Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes |
7,652 |
2,770 |
$490K |
| G0153 |
Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes |
7,703 |
2,506 |
$482K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,378 |
2,335 |
$451K |
| G0152 |
Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes |
6,612 |
2,293 |
$429K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,682 |
4,465 |
$377K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,721 |
2,451 |
$265K |
| 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 |
886 |
706 |
$217K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,938 |
1,847 |
$207K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,421 |
2,297 |
$199K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,181 |
2,053 |
$197K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,371 |
1,314 |
$157K |
| 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 |
1,985 |
1,141 |
$153K |
| B4100 |
Food thickener, administered orally, per ounce |
1,469 |
1,238 |
$136K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,770 |
1,688 |
$122K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
976 |
917 |
$112K |
| B9998 |
Noc for enteral supplies |
728 |
574 |
$106K |
| E0570 |
Nebulizer, with compressor |
784 |
772 |
$100K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,608 |
2,509 |
$93K |
| 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 |
1,136 |
712 |
$92K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
806 |
729 |
$90K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
2,094 |
1,856 |
$82K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
919 |
882 |
$78K |
| 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 |
1,811 |
1,465 |
$73K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
476 |
354 |
$56K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
460 |
441 |
$32K |
| K0001 |
Standard wheelchair |
680 |
647 |
$32K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
593 |
334 |
$30K |
| J3490 |
Unclassified drugs |
398 |
80 |
$27K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
134 |
87 |
$24K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,127 |
988 |
$21K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
515 |
325 |
$21K |
| A4927 |
Gloves, non-sterile, per 100 |
2,078 |
1,978 |
$19K |
| T1001 |
Nursing assessment / evaluation |
1,499 |
1,417 |
$19K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
1,119 |
314 |
$19K |
| A4670 |
Automatic blood pressure monitor |
426 |
417 |
$18K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
180 |
172 |
$18K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
312 |
302 |
$14K |
| S9542 |
Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
131 |
55 |
$12K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,249 |
974 |
$11K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
134 |
107 |
$9K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
82 |
78 |
$9K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
692 |
517 |
$8K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
177 |
127 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,908 |
1,252 |
$4K |
| S9562 |
Home injectable therapy, palivizumab or other monoclonal antibody for rsv, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
271 |
251 |
$4K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
43 |
39 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
113 |
109 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,751 |
1,418 |
$3K |
| A4322 |
Irrigation syringe, bulb or piston, each |
612 |
453 |
$2K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
180 |
162 |
$2K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
42 |
38 |
$2K |
| A4402 |
Lubricant, per ounce |
884 |
823 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
159 |
154 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
418 |
321 |
$2K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
12 |
12 |
$972.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
109 |
103 |
$951.93 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
17 |
12 |
$784.50 |
| E0202 |
Phototherapy (bilirubin) light with photometer |
17 |
12 |
$764.03 |
| A6237 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
39 |
38 |
$762.50 |
| E1399 |
Durable medical equipment, miscellaneous |
12 |
12 |
$730.78 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
77 |
75 |
$646.26 |
| B4082 |
Nasogastric tubing without stylet |
37 |
24 |
$619.47 |
| A4398 |
Ostomy irrigation supply; bag, each |
185 |
131 |
$587.20 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
207 |
185 |
$451.96 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
155 |
143 |
$190.34 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
15 |
14 |
$50.05 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
33 |
13 |
$14.67 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
91 |
72 |
$0.00 |