| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,541 |
2,284 |
$1.72M |
| 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 |
1,911 |
1,189 |
$1.28M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
10,663 |
10,222 |
$1.27M |
| S9435 |
Medical foods for inborn errors of metabolism |
2,315 |
1,547 |
$1.10M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,835 |
3,277 |
$954K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
4,821 |
4,610 |
$935K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,998 |
1,602 |
$739K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
746 |
666 |
$544K |
| B9002 |
Enteral nutrition infusion pump, any type |
4,766 |
4,267 |
$428K |
| B4100 |
Food thickener, administered orally, per ounce |
2,247 |
2,120 |
$353K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,917 |
2,709 |
$246K |
| B9998 |
Noc for enteral supplies |
3,964 |
2,847 |
$149K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,583 |
1,438 |
$128K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,129 |
1,009 |
$118K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
2,695 |
2,338 |
$75K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
876 |
779 |
$74K |
| 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 |
315 |
273 |
$66K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
503 |
490 |
$61K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
384 |
371 |
$46K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
339 |
289 |
$25K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
201 |
147 |
$24K |
| 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 |
59 |
54 |
$19K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
154 |
146 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
573 |
522 |
$11K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
110 |
91 |
$10K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
71 |
70 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
591 |
531 |
$4K |
| A4657 |
Syringe, with or without needle, each |
475 |
420 |
$970.08 |