| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,093 |
2,888 |
$1.05M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,483 |
1,331 |
$951K |
| B4035 |
Enteral feed supp pump per d |
2,569 |
2,374 |
$656K |
| B4162 |
Ef ped specmetabolic inherit |
826 |
658 |
$404K |
| B4088 |
Gastro/jejuno tube, low-pro |
2,601 |
2,145 |
$365K |
| B9998 |
Enteral supp not otherwise c |
3,195 |
2,659 |
$228K |
| B4149 |
Ef blenderized foods |
403 |
378 |
$173K |
| T4534 |
Youth size pull-on |
940 |
926 |
$160K |
| B4158 |
Ef ped complete intact nut |
636 |
600 |
$145K |
| B4100 |
Food thickener oral |
933 |
759 |
$75K |
| B9002 |
Enter nutr inf pump any type |
790 |
741 |
$49K |
| A4554 |
Disposable underpads |
1,224 |
1,178 |
$45K |
| B4155 |
Ef incomplete/modular |
248 |
239 |
$42K |
| A4927 |
Non-sterile gloves |
1,358 |
1,307 |
$32K |
| A4322 |
Irrigation syringe |
1,792 |
1,670 |
$17K |
| A4452 |
Waterproof tape |
2,092 |
1,981 |
$15K |
| B4103 |
Ef ped fluid and electrolyte |
120 |
106 |
$12K |
| A4344 |
Cath indw foley 2 way silicn |
224 |
191 |
$11K |
| A4351 |
Straight tip urine catheter |
444 |
419 |
$11K |
| A6402 |
Sterile gauze <= 16 sq in |
1,860 |
1,769 |
$9K |
| E0776 |
Iv pole |
535 |
506 |
$6K |
| A9286 |
Any hygienic item, device |
1,130 |
1,110 |
$6K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
73 |
66 |
$3K |
| A4402 |
Lubricant per ounce |
350 |
334 |
$3K |
| B4150 |
Ef complet w/intact nutrient |
27 |
24 |
$2K |
| A6250 |
Skin seal protect moisturizr |
200 |
191 |
$2K |
| B4081 |
Enteral ng tubing w/ stylet |
28 |
24 |
$2K |
| B4036 |
Enteral feed sup kit grav by |
45 |
38 |
$1K |
| A6257 |
Transparent film <= 16 sq in |
118 |
105 |
$1K |
| B4034 |
Enter feed supkit syr by day |
13 |
12 |
$1K |
| B4104 |
Additive for enteral formula |
25 |
24 |
$1K |
| A4213 |
20+ cc syringe only |
27 |
24 |
$260.56 |