| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
608 |
514 |
$105K |
| 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 |
74 |
59 |
$12K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
115 |
99 |
$7K |
| B9998 |
Noc for enteral supplies |
113 |
65 |
$4K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
15 |
13 |
$1K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
27 |
27 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
46 |
41 |
$213.04 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
14 |
14 |
$81.78 |
| S8189 |
Tracheostomy supply, not otherwise classified |
40 |
15 |
$71.28 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
17 |
13 |
$62.95 |
| A4927 |
Gloves, non-sterile, per 100 |
12 |
12 |
$26.02 |
| B9002 |
Enteral nutrition infusion pump, any type |
18 |
12 |
$24.48 |
| A4210 |
Needle-free injection device, each |
27 |
25 |
$7.11 |