| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0776 |
Iv pole |
2,006 |
1,793 |
$0.00 |
| 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 |
966 |
904 |
$0.00 |
| A7526 |
Tracheostomy tube collar/holder, each |
12 |
12 |
$0.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
54 |
54 |
$0.00 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
43 |
41 |
$0.00 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
15 |
12 |
$0.00 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
133 |
128 |
$0.00 |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
53 |
50 |
$0.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
103 |
91 |
$0.00 |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
988 |
907 |
$0.00 |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
611 |
562 |
$0.00 |
| A4623 |
Tracheostomy, inner cannula |
15 |
12 |
$0.00 |
| B9002 |
Enteral nutrition infusion pump, any type |
181 |
170 |
$0.00 |