| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
2,198 |
1,973 |
$1.24M |
| B4035 |
Enteral feed supp pump per d |
6,344 |
5,045 |
$1.12M |
| B4149 |
Ef blenderized foods |
2,357 |
1,691 |
$838K |
| J1559 |
Hizentra injection |
566 |
168 |
$598K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,813 |
3,379 |
$575K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,450 |
2,114 |
$398K |
| B4087 |
Gastro/jejuno tube, std |
2,843 |
2,215 |
$261K |
| B4150 |
Ef complet w/intact nutrient |
2,212 |
1,768 |
$260K |
| A4223 |
Infusion supplies w/o pump |
1,515 |
677 |
$259K |
| A4222 |
Infusion supplies with pump |
1,334 |
503 |
$182K |
| B4034 |
Enter feed supkit syr by day |
1,691 |
1,500 |
$129K |
| A4221 |
Supp non-insulin inf cath/wk |
5,909 |
2,648 |
$119K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,742 |
1,647 |
$108K |
| B9002 |
Enter nutr inf pump any type |
1,065 |
989 |
$80K |
| B4153 |
Ef hydrolyzed/amino acids |
44 |
41 |
$23K |
| B4224 |
Parenteral administration ki |
227 |
49 |
$21K |
| B4155 |
Ef incomplete/modular |
231 |
206 |
$11K |
| B4185 |
Pn soln nos 10 grams lipids |
46 |
12 |
$10K |
| B4100 |
Food thickener oral |
262 |
238 |
$8K |
| 99601 |
|
69 |
51 |
$7K |
| B4220 |
Parenteral supply kit premix |
227 |
49 |
$7K |
| E0781 |
External ambulatory infus pu |
12 |
12 |
$3K |
| S9460 |
Diabetic management program, |
21 |
12 |
$3K |
| S9470 |
Nutritional counseling, diet |
13 |
12 |
$0.00 |