| 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 |
3,093 |
2,888 |
$1.05M |
| 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 |
1,483 |
1,331 |
$951K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,569 |
2,374 |
$656K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
826 |
658 |
$404K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,601 |
2,145 |
$365K |
| B9998 |
Noc for enteral supplies |
3,195 |
2,659 |
$228K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
403 |
378 |
$173K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
940 |
926 |
$160K |
| 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 |
636 |
600 |
$145K |
| B4100 |
Food thickener, administered orally, per ounce |
933 |
759 |
$75K |
| B9002 |
Enteral nutrition infusion pump, any type |
790 |
741 |
$49K |
| A4554 |
Disposable underpads, all sizes |
1,224 |
1,178 |
$45K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
248 |
239 |
$42K |
| A4927 |
Gloves, non-sterile, per 100 |
1,358 |
1,307 |
$32K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,792 |
1,670 |
$17K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,092 |
1,981 |
$15K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
120 |
106 |
$12K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
224 |
191 |
$11K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
444 |
419 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,860 |
1,769 |
$9K |
| E0776 |
Iv pole |
535 |
506 |
$6K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
1,130 |
1,110 |
$6K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
73 |
66 |
$3K |
| A4402 |
Lubricant, per ounce |
350 |
334 |
$3K |
| 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 |
27 |
24 |
$2K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
200 |
191 |
$2K |
| B4081 |
Nasogastric tubing with stylet |
28 |
24 |
$2K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
45 |
38 |
$1K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
118 |
105 |
$1K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13 |
12 |
$1K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
25 |
24 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
27 |
24 |
$260.56 |