| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
26,721 |
12,500 |
$182K |
| 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 |
18,482 |
8,462 |
$93K |
| 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 |
8,512 |
4,253 |
$67K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,927 |
1,655 |
$20K |
| B9002 |
Enteral nutrition infusion pump, any type |
5,483 |
3,766 |
$15K |
| E0776 |
Iv pole |
5,738 |
4,287 |
$13K |
| 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 |
1,968 |
1,156 |
$7K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
2,842 |
1,901 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,994 |
1,939 |
$1K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
782 |
547 |
$712.71 |
| A4456 |
Adhesive remover, wipes, any type, each |
1,187 |
811 |
$420.32 |
| A5120 |
Skin barrier, wipes or swabs, each |
805 |
535 |
$224.04 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
56 |
38 |
$190.62 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
2,828 |
1,886 |
$93.22 |
| A4623 |
Tracheostomy, inner cannula |
13 |
12 |
$0.00 |
| A7526 |
Tracheostomy tube collar/holder, each |
16 |
12 |
$0.00 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
47 |
37 |
$0.00 |