| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,066 |
2,007 |
$640K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,171 |
1,115 |
$226K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
43 |
37 |
$6K |
| B9998 |
Noc for enteral supplies |
1,258 |
1,176 |
$300.00 |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
141 |
115 |
$31.56 |
| A4245 |
Alcohol wipes, per box |
535 |
434 |
$0.00 |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
939 |
679 |
$0.00 |
| A4550 |
Surgical trays |
172 |
168 |
$0.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,038 |
1,008 |
$0.00 |
| A4649 |
Surgical supply; miscellaneous |
577 |
391 |
$0.00 |
| A4927 |
Gloves, non-sterile, per 100 |
224 |
122 |
$0.00 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
139 |
121 |
$0.00 |
| T5999 |
Supply, not otherwise specified |
109 |
63 |
$0.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
813 |
788 |
$0.00 |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,649 |
1,561 |
$0.00 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
14 |
12 |
$0.00 |
| A4930 |
Gloves, sterile, per pair |
192 |
156 |
$0.00 |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
27 |
15 |
$0.00 |