| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4162 |
Ef ped specmetabolic inherit |
2,541 |
2,284 |
$1.72M |
| B4157 |
Ef special metabolic inherit |
1,911 |
1,189 |
$1.28M |
| T4534 |
Youth size pull-on |
10,663 |
10,222 |
$1.27M |
| S9435 |
Medical foods for inborn err |
2,315 |
1,547 |
$1.10M |
| B4035 |
Enteral feed supp pump per d |
3,835 |
3,277 |
$954K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,821 |
4,610 |
$935K |
| B4149 |
Ef blenderized foods |
1,998 |
1,602 |
$739K |
| B4161 |
Ef ped hydrolyzed/amino acid |
746 |
666 |
$544K |
| B9002 |
Enter nutr inf pump any type |
4,766 |
4,267 |
$428K |
| B4100 |
Food thickener oral |
2,247 |
2,120 |
$353K |
| T4530 |
Ped size brief/diaper lg |
2,917 |
2,709 |
$246K |
| B9998 |
Enteral supp not otherwise c |
3,964 |
2,847 |
$149K |
| T4533 |
Youth size brief/diaper |
1,583 |
1,438 |
$128K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,129 |
1,009 |
$118K |
| A4213 |
20+ cc syringe only |
2,695 |
2,338 |
$75K |
| T4522 |
Adult size brief/diaper med |
876 |
779 |
$74K |
| B4150 |
Ef complet w/intact nutrient |
315 |
273 |
$66K |
| T4526 |
Adult size pull-on med |
503 |
490 |
$61K |
| T4525 |
Adult size pull-on sm |
384 |
371 |
$46K |
| T4521 |
Adult size brief/diaper sm |
339 |
289 |
$25K |
| B4155 |
Ef incomplete/modular |
201 |
147 |
$24K |
| B4152 |
Ef calorie dense>/=1.5kcal |
59 |
54 |
$19K |
| T4527 |
Adult size pull-on lg |
154 |
146 |
$19K |
| A4927 |
Non-sterile gloves |
573 |
522 |
$11K |
| B4103 |
Ef ped fluid and electrolyte |
110 |
91 |
$10K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
71 |
70 |
$7K |
| A6402 |
Sterile gauze <= 16 sq in |
591 |
531 |
$4K |
| A4657 |
Syringe w/wo needle |
475 |
420 |
$970.08 |