| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
8,008 |
4,415 |
$408K |
| B4034 |
Enter feed supkit syr by day |
3,386 |
2,042 |
$157K |
| B4152 |
Ef calorie dense>/=1.5kcal |
5,026 |
2,586 |
$150K |
| B4150 |
Ef complet w/intact nutrient |
2,477 |
1,492 |
$150K |
| B4154 |
Ef spec metabolic noninherit |
2,899 |
1,368 |
$96K |
| B9002 |
Enter nutr inf pump any type |
2,280 |
1,343 |
$40K |
| B4155 |
Ef incomplete/modular |
759 |
489 |
$17K |
| A5063 |
Drain ostomy pouch w/flange |
910 |
557 |
$3K |
| B4088 |
Gastro/jejuno tube, low-pro |
16 |
16 |
$2K |
| A4357 |
Bedside drainage bag |
732 |
636 |
$751.69 |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
62 |
37 |
$386.10 |
| A4311 |
Catheter w/o bag 2-way latex |
335 |
306 |
$216.46 |
| A5061 |
Pouch drainable w barrier at |
20 |
12 |
$154.38 |
| A4338 |
Indwelling catheter latex |
92 |
82 |
$66.66 |
| A4310 |
Insert tray w/o bag/cath |
131 |
115 |
$57.52 |
| A6212 |
Foam drg <=16 sq in w/border |
88 |
88 |
$3.39 |
| A6196 |
Alginate dressing <=16 sq in |
82 |
82 |
$0.00 |
| A6402 |
Sterile gauze <= 16 sq in |
108 |
88 |
$0.00 |