| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
116,889 |
103,364 |
$36.05M |
| B4161 |
Ef ped hydrolyzed/amino acid |
43,575 |
37,620 |
$31.78M |
| B4035 |
Enteral feed supp pump per d |
98,248 |
89,099 |
$24.60M |
| B4149 |
Ef blenderized foods |
35,331 |
30,706 |
$12.25M |
| B4088 |
Gastro/jejuno tube, low-pro |
74,281 |
65,232 |
$9.97M |
| B9998 |
Enteral supp not otherwise c |
108,183 |
83,335 |
$8.25M |
| B4153 |
Ef hydrolyzed/amino acids |
8,258 |
6,948 |
$4.56M |
| T4534 |
Youth size pull-on |
24,116 |
22,461 |
$4.26M |
| B4155 |
Ef incomplete/modular |
23,921 |
20,761 |
$4.18M |
| B4158 |
Ef ped complete intact nut |
16,775 |
14,581 |
$3.88M |
| B4152 |
Ef calorie dense>/=1.5kcal |
28,121 |
23,059 |
$3.88M |
| B4150 |
Ef complet w/intact nutrient |
35,122 |
29,121 |
$3.55M |
| B4154 |
Ef spec metabolic noninherit |
12,384 |
9,849 |
$3.11M |
| B4100 |
Food thickener oral |
25,849 |
21,064 |
$2.27M |
| B9002 |
Enter nutr inf pump any type |
29,232 |
26,383 |
$1.84M |
| A4554 |
Disposable underpads |
32,950 |
30,987 |
$1.69M |
| T4530 |
Ped size brief/diaper lg |
16,952 |
15,914 |
$1.59M |
| B4103 |
Ef ped fluid and electrolyte |
20,212 |
16,687 |
$1.33M |
| B4034 |
Enter feed supkit syr by day |
9,429 |
8,356 |
$1.16M |
| B4104 |
Additive for enteral formula |
14,766 |
12,576 |
$1.09M |
| T4522 |
Adult size brief/diaper med |
6,978 |
6,493 |
$961K |
| A4927 |
Non-sterile gloves |
36,555 |
33,972 |
$778K |
| B4036 |
Enteral feed sup kit grav by |
3,498 |
3,086 |
$580K |
| A6212 |
Foam drg <=16 sq in w/border |
1,577 |
1,216 |
$469K |
| T4526 |
Adult size pull-on med |
3,382 |
3,137 |
$465K |
| B4162 |
Ef ped specmetabolic inherit |
1,138 |
870 |
$461K |
| T4521 |
Adult size brief/diaper sm |
3,959 |
3,668 |
$449K |
| T4523 |
Adult size brief/diaper lg |
2,603 |
2,391 |
$415K |
| T4532 |
Ped size pull-on lg |
3,055 |
2,857 |
$351K |
| A6250 |
Skin seal protect moisturizr |
27,924 |
25,361 |
$276K |
| T4525 |
Adult size pull-on sm |
2,658 |
2,474 |
$253K |
| T4527 |
Adult size pull-on lg |
1,241 |
1,160 |
$221K |
| B4081 |
Enteral ng tubing w/ stylet |
4,245 |
2,903 |
$216K |
| E0776 |
Iv pole |
5,283 |
4,327 |
$213K |
| A9901 |
Delivery/set up/dispensing |
12,970 |
6,518 |
$184K |
| T4533 |
Youth size brief/diaper |
1,524 |
1,422 |
$150K |
| T4535 |
Disposable liner/shield/pad |
3,798 |
3,543 |
$143K |
| A4385 |
Ost skn barrier sld ext wear |
758 |
635 |
$134K |
| A4351 |
Straight tip urine catheter |
1,232 |
1,035 |
$128K |
| A9286 |
Any hygienic item, device |
8,578 |
7,678 |
$68K |
| B4102 |
Ef adult fluids and electro |
2,620 |
2,166 |
$51K |
| A4344 |
Cath indw foley 2 way silicn |
1,220 |
1,019 |
$39K |
| A4425 |
Ost pch drain for barrier fl |
567 |
404 |
$34K |
| T4531 |
Ped size pull-on sm/med |
272 |
262 |
$29K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
138 |
116 |
$27K |
| T4528 |
Adult size pull-on xl |
169 |
148 |
$27K |
| A9999 |
Dme supply or accessory, nos |
1,913 |
1,713 |
$20K |
| A6260 |
Wound cleanser any type/size |
2,322 |
2,111 |
$12K |
| B4159 |
Ef ped complete soy based |
65 |
49 |
$12K |
| A6402 |
Sterile gauze <= 16 sq in |
739 |
657 |
$10K |
| A4402 |
Lubricant per ounce |
1,648 |
1,423 |
$9K |
| A5120 |
Skin barrier, wipe or swab |
1,018 |
811 |
$8K |
| B4082 |
Enteral ng tubing w/o stylet |
277 |
203 |
$6K |
| A4357 |
Bedside drainage bag |
342 |
297 |
$5K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
14 |
13 |
$4K |
| A4322 |
Irrigation syringe |
722 |
663 |
$4K |
| A4371 |
Skin barrier powder per oz |
432 |
388 |
$2K |
| A4335 |
Incontinence supply |
93 |
75 |
$2K |
| A4409 |
Ost skn barr convex <=4 sq i |
12 |
12 |
$2K |
| A4452 |
Waterproof tape |
271 |
251 |
$2K |
| A4421 |
Ostomy supply misc |
15 |
13 |
$653.72 |
| A4455 |
Adhesive remover per ounce |
157 |
113 |
$537.60 |
| B4087 |
Gastro/jejuno tube, std |
24 |
15 |
$308.23 |
| A4213 |
20+ cc syringe only |
72 |
71 |
$301.89 |
| S9342 |
Hit enteral pump diem |
110 |
106 |
$0.00 |