| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
8,912 |
7,718 |
$4.45M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
14,778 |
11,171 |
$2.56M |
| B4035 |
Enteral feed supp pump per d |
6,546 |
6,162 |
$1.61M |
| B9998 |
Enteral supp not otherwise c |
11,128 |
8,289 |
$714K |
| B4155 |
Ef incomplete/modular |
2,845 |
2,719 |
$699K |
| B4150 |
Ef complet w/intact nutrient |
2,322 |
1,910 |
$466K |
| B4149 |
Ef blenderized foods |
1,749 |
1,132 |
$431K |
| E0603 |
Electric breast pump |
3,027 |
2,928 |
$395K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,154 |
1,037 |
$323K |
| B4158 |
Ef ped complete intact nut |
1,453 |
1,391 |
$295K |
| B4153 |
Ef hydrolyzed/amino acids |
246 |
238 |
$284K |
| T4534 |
Youth size pull-on |
2,621 |
2,500 |
$273K |
| B4100 |
Food thickener oral |
961 |
940 |
$227K |
| B4034 |
Enter feed supkit syr by day |
957 |
940 |
$117K |
| A4554 |
Disposable underpads |
4,616 |
4,445 |
$111K |
| E0570 |
Nebulizer with compression |
944 |
919 |
$96K |
| T4530 |
Ped size brief/diaper lg |
869 |
858 |
$77K |
| B9002 |
Enter nutr inf pump any type |
567 |
522 |
$64K |
| A4322 |
Irrigation syringe |
6,553 |
6,143 |
$47K |
| B4154 |
Ef spec metabolic noninherit |
84 |
77 |
$39K |
| A6530 |
Compression stocking bk18-30 |
273 |
213 |
$28K |
| A4335 |
Incontinence supply |
6,339 |
5,996 |
$26K |
| B4103 |
Ef ped fluid and electrolyte |
109 |
87 |
$16K |
| T4522 |
Adult size brief/diaper med |
134 |
130 |
$13K |
| A7000 |
Disposable canister for pump |
478 |
471 |
$12K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,919 |
2,772 |
$7K |
| T1999 |
Noc retail items andsupplies |
4,986 |
3,263 |
$7K |
| B4104 |
Additive for enteral formula |
96 |
83 |
$7K |
| A4467 |
Belt strap sleev grmnt cover |
106 |
104 |
$4K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
68 |
64 |
$4K |
| A4927 |
Non-sterile gloves |
604 |
592 |
$4K |
| A7002 |
Tubing used w suction pump |
462 |
459 |
$4K |
| L2630 |
Pelvic control band & belt u |
58 |
57 |
$3K |
| E0776 |
Iv pole |
411 |
389 |
$3K |
| A4628 |
Oropharyngeal suction cath |
380 |
333 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
220 |
212 |
$1K |
| A7003 |
Nebulizer administration set |
463 |
436 |
$1K |
| A6257 |
Transparent film <= 16 sq in |
85 |
80 |
$1K |
| T4521 |
Adult size brief/diaper sm |
12 |
12 |
$1K |
| A4450 |
Non-waterproof tape |
880 |
836 |
$1K |
| B4081 |
Enteral ng tubing w/ stylet |
29 |
25 |
$1K |
| A4627 |
Spacer bag/reservoir |
36 |
36 |
$915.42 |
| A7015 |
Aerosol mask used w nebulize |
501 |
494 |
$572.20 |
| A4402 |
Lubricant per ounce |
193 |
178 |
$512.86 |
| A4213 |
20+ cc syringe only |
242 |
234 |
$326.28 |