| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4157 |
Enteral formula, nutritionally complete, for 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 |
1,512 |
1,461 |
$1.10M |
| 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 |
557 |
542 |
$325K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
556 |
541 |
$61K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
250 |
236 |
$41K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
230 |
189 |
$30K |
| A4554 |
Disposable underpads, all sizes |
489 |
471 |
$28K |
| 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 |
26 |
25 |
$7K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
42 |
38 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
129 |
113 |
$3K |
| A4259 |
Lancets, per box of 100 |
219 |
181 |
$2K |
| E0570 |
Nebulizer, with compressor |
18 |
16 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
125 |
112 |
$203.13 |
| 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 |
32 |
32 |
$0.00 |
| 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 |
28 |
28 |
$0.00 |