| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
1,811 |
1,399 |
$261K |
| B4035 |
Enteral feed supp pump per d |
3,463 |
2,745 |
$178K |
| B4150 |
Ef complet w/intact nutrient |
5,241 |
4,254 |
$135K |
| B4154 |
Ef spec metabolic noninherit |
2,184 |
1,807 |
$96K |
| B4036 |
Enteral feed sup kit grav by |
3,525 |
2,660 |
$54K |
| B4034 |
Enter feed supkit syr by day |
168 |
153 |
$9K |
| B4152 |
Ef calorie dense>/=1.5kcal |
763 |
625 |
$8K |
| B4088 |
Gastro/jejuno tube, low-pro |
512 |
485 |
$4K |
| B9002 |
Enter nutr inf pump any type |
622 |
530 |
$3K |
| E0776 |
Iv pole |
693 |
591 |
$140.00 |
| S9999 |
Sales tax |
79 |
74 |
$0.00 |
| B4155 |
Ef incomplete/modular |
49 |
36 |
$0.00 |
| B9998 |
Enteral supp not otherwise c |
1,085 |
768 |
$0.00 |
| B4149 |
Ef blenderized foods |
49 |
38 |
$0.00 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
61 |
51 |
$0.00 |