| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9374 |
Hit hydra 1 liter diem |
5,256 |
1,604 |
$961K |
| S9366 |
Hit tpn 2 liter diem |
3,749 |
571 |
$652K |
| 99601 |
|
8,473 |
3,397 |
$620K |
| B4161 |
Ef ped hydrolyzed/amino acid |
15,094 |
10,812 |
$553K |
| S9379 |
Hit noc per diem |
7,238 |
1,744 |
$504K |
| S9500 |
Hit antibiotic q24h diem |
4,294 |
1,835 |
$478K |
| S9365 |
Hit tpn 1 liter diem |
2,342 |
262 |
$441K |
| A4223 |
Infusion supplies w/o pump |
3,401 |
1,474 |
$329K |
| S9502 |
Hit antibiotic q8h diem |
2,428 |
1,020 |
$296K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
30,765 |
21,652 |
$231K |
| J1561 |
Gamunex-c/gammaked |
137 |
88 |
$142K |
| S9338 |
Hit immunotherapy diem |
2,622 |
1,765 |
$126K |
| S9501 |
Hit antibiotic q12h diem |
2,097 |
746 |
$124K |
| B4035 |
Enteral feed supp pump per d |
2,733 |
2,258 |
$117K |
| S9375 |
Hit hydra 2 liter diem |
1,295 |
279 |
$105K |
| B4185 |
Pn soln nos 10 grams lipids |
1,248 |
363 |
$91K |
| J1559 |
Hizentra injection |
545 |
294 |
$85K |
| J1569 |
Gammagard liquid injection |
199 |
121 |
$84K |
| S9367 |
Hit tpn 3 liter diem |
427 |
58 |
$72K |
| 99602 |
Nursing care in home rn |
1,562 |
914 |
$69K |
| B9002 |
Enter nutr inf pump any type |
1,517 |
1,367 |
$63K |
| S5501 |
Hit complex cath care |
1,053 |
582 |
$52K |
| B4150 |
Ef complet w/intact nutrient |
5,795 |
4,067 |
$46K |
| S5502 |
Hit interim cath care |
1,914 |
1,556 |
$41K |
| S9123 |
Nursing care in home rn |
967 |
431 |
$38K |
| J0878 |
Daptomycin injection |
1,882 |
214 |
$38K |
| S9342 |
Hit enteral pump diem |
19,959 |
18,344 |
$38K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,377 |
2,807 |
$33K |
| B4158 |
Ef ped complete intact nut |
2,234 |
1,762 |
$28K |
| G0299 |
Hhs/hospice of rn ea 15 min |
8,898 |
3,112 |
$25K |
| A4221 |
Supp non-insulin inf cath/wk |
4,513 |
2,161 |
$23K |
| J1335 |
Ertapenem injection |
986 |
435 |
$23K |
| B4224 |
Parenteral administration ki |
925 |
260 |
$18K |
| J3490 |
Drugs unclassified injection |
830 |
217 |
$18K |
| B4149 |
Ef blenderized foods |
5,758 |
4,005 |
$18K |
| J1459 |
Inj ivig privigen 500 mg |
60 |
39 |
$16K |
| S9503 |
Hit antibiotic q6h diem |
190 |
85 |
$13K |
| J1745 |
Infliximab not biosimil 10mg |
237 |
229 |
$13K |
| J3370 |
Vancomycin hcl injection |
2,050 |
875 |
$9K |
| J2997 |
Alteplase recombinant |
137 |
116 |
$7K |
| A4222 |
Infusion supplies with pump |
607 |
259 |
$7K |
| S5498 |
Hit simple cath care |
353 |
202 |
$7K |
| B4034 |
Enter feed supkit syr by day |
419 |
352 |
$6K |
| B4220 |
Parenteral supply kit premix |
925 |
260 |
$6K |
| B4154 |
Ef spec metabolic noninherit |
1,258 |
955 |
$6K |
| B4153 |
Ef hydrolyzed/amino acids |
1,647 |
1,153 |
$5K |
| B4088 |
Gastro/jejuno tube, low-pro |
331 |
288 |
$4K |
| J7030 |
Normal saline solution infus |
941 |
405 |
$4K |
| B4103 |
Ef ped fluid and electrolyte |
2,256 |
1,660 |
$3K |
| B4100 |
Food thickener oral |
1,542 |
1,293 |
$3K |
| S9542 |
Ht inj noc per diem |
6,838 |
5,921 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
1,667 |
691 |
$3K |
| B4155 |
Ef incomplete/modular |
4,683 |
3,589 |
$2K |
| J0690 |
Cefazolin sodium injection |
966 |
400 |
$2K |
| J0692 |
Cefepime hcl for injection |
668 |
295 |
$2K |
| B4104 |
Additive for enteral formula |
1,516 |
1,290 |
$1K |
| J2543 |
Piperacillin/tazobactam |
272 |
122 |
$1K |
| B9998 |
Enteral supp not otherwise c |
119 |
96 |
$393.96 |
| B4102 |
Ef adult fluids and electro |
869 |
705 |
$264.67 |
| B4081 |
Enteral ng tubing w/ stylet |
14 |
12 |
$257.01 |
| J1642 |
Inj heparin sodium per 10 u |
586 |
294 |
$99.52 |
| S9343 |
Hit enteral bolus nurs |
4,180 |
3,973 |
$91.90 |
| J7050 |
Normal saline solution infus |
447 |
213 |
$73.45 |
| A4216 |
Sterile water/saline, 10 ml |
675 |
321 |
$8.06 |
| A4217 |
Sterile water/saline, 500 ml |
48 |
17 |
$5.38 |
| B4162 |
Ef ped specmetabolic inherit |
208 |
175 |
$1.16 |
| A4211 |
Supp for self-adm injections |
43 |
28 |
$0.96 |
| A4452 |
Waterproof tape |
24 |
21 |
$0.60 |
| A6402 |
Sterile gauze <= 16 sq in |
72 |
62 |
$0.10 |
| J1438 |
Etanercept injection |
1,895 |
1,747 |
$0.00 |
| J1595 |
Injection glatiramer acetate |
29 |
28 |
$0.00 |
| A4450 |
Non-waterproof tape |
18 |
13 |
$0.00 |
| J0135 |
Adalimumab injection |
3,519 |
3,157 |
$0.00 |
| J2941 |
Somatropin injection |
1,799 |
1,591 |
$0.00 |
| S9341 |
Hit enteral grav diem |
607 |
545 |
$0.00 |
| B4157 |
Ef special metabolic inherit |
238 |
167 |
$0.00 |
| J7040 |
Normal saline solution infus |
58 |
26 |
$0.00 |