| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
2,066 |
2,007 |
$640K |
| B4034 |
Enter feed supkit syr by day |
1,171 |
1,115 |
$226K |
| B4088 |
Gastro/jejuno tube, low-pro |
43 |
37 |
$6K |
| B9998 |
Enteral supp not otherwise c |
1,258 |
1,176 |
$300.00 |
| A4221 |
Supp non-insulin inf cath/wk |
141 |
115 |
$31.56 |
| A4245 |
Alcohol wipes per box |
535 |
434 |
$0.00 |
| A4223 |
Infusion supplies w/o pump |
939 |
679 |
$0.00 |
| A4550 |
Surgical trays |
172 |
168 |
$0.00 |
| A6402 |
Sterile gauze <= 16 sq in |
1,038 |
1,008 |
$0.00 |
| A4649 |
Surgical supplies |
577 |
391 |
$0.00 |
| A4927 |
Non-sterile gloves |
224 |
122 |
$0.00 |
| A6457 |
Tubular dressing |
139 |
121 |
$0.00 |
| T5999 |
Supply, nos |
109 |
63 |
$0.00 |
| A4450 |
Non-waterproof tape |
813 |
788 |
$0.00 |
| A4322 |
Irrigation syringe |
1,649 |
1,561 |
$0.00 |
| A4213 |
20+ cc syringe only |
14 |
12 |
$0.00 |
| A4930 |
Sterile, gloves per pair |
192 |
156 |
$0.00 |
| A4209 |
5+ cc sterile syringe&needle |
27 |
15 |
$0.00 |