| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
3,930 |
3,789 |
$2.46M |
| B4157 |
Ef special metabolic inherit |
1,003 |
948 |
$1.31M |
| B4155 |
Ef incomplete/modular |
1,679 |
1,595 |
$631K |
| B4154 |
Ef spec metabolic noninherit |
1,148 |
1,087 |
$619K |
| B4162 |
Ef ped specmetabolic inherit |
299 |
282 |
$383K |
| B4035 |
Enteral feed supp pump per d |
1,575 |
1,490 |
$258K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,126 |
1,060 |
$205K |
| A4554 |
Disposable underpads |
3,164 |
2,859 |
$192K |
| T4522 |
Adult size brief/diaper med |
978 |
889 |
$94K |
| T4533 |
Youth size brief/diaper |
894 |
850 |
$75K |
| T4523 |
Adult size brief/diaper lg |
526 |
491 |
$64K |
| B4150 |
Ef complet w/intact nutrient |
376 |
357 |
$59K |
| B9002 |
Enter nutr inf pump any type |
63 |
61 |
$37K |
| B4088 |
Gastro/jejuno tube, low-pro |
278 |
278 |
$36K |
| B4152 |
Ef calorie dense>/=1.5kcal |
311 |
293 |
$36K |
| T4521 |
Adult size brief/diaper sm |
282 |
268 |
$28K |
| T4537 |
Reusable underpad bed size |
524 |
458 |
$14K |
| L3000 |
Ft insert ucb berkeley shell |
32 |
13 |
$7K |
| T4530 |
Ped size brief/diaper lg |
43 |
39 |
$3K |
| L3215 |
Orthopedic ftwear ladies oxf |
48 |
19 |
$3K |
| L3219 |
Orthopedic mens shoes oxford |
34 |
13 |
$2K |
| B4034 |
Enter feed supkit syr by day |
26 |
26 |
$2K |
| L3060 |
Foot arch supp longitud/meta |
40 |
16 |
$2K |
| A4927 |
Non-sterile gloves |
320 |
283 |
$1K |