| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,930 |
3,789 |
$2.46M |
| 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 |
1,003 |
948 |
$1.31M |
| 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 |
1,679 |
1,595 |
$631K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,148 |
1,087 |
$619K |
| 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 |
299 |
282 |
$383K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,575 |
1,490 |
$258K |
| 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 |
1,126 |
1,060 |
$205K |
| A4554 |
Disposable underpads, all sizes |
3,164 |
2,859 |
$192K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
978 |
889 |
$94K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
894 |
850 |
$75K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
526 |
491 |
$64K |
| 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 |
376 |
357 |
$59K |
| B9002 |
Enteral nutrition infusion pump, any type |
63 |
61 |
$37K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
278 |
278 |
$36K |
| 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 |
311 |
293 |
$36K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
282 |
268 |
$28K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
524 |
458 |
$14K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
32 |
13 |
$7K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
43 |
39 |
$3K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
48 |
19 |
$3K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
34 |
13 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
26 |
26 |
$2K |
| L3060 |
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
40 |
16 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
320 |
283 |
$1K |