| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Ther cgm supply allowance |
20,360 |
20,051 |
$5.54M |
| B4162 |
Ef ped specmetabolic inherit |
7,045 |
6,094 |
$5.22M |
| A4239 |
Non-adju cgm supply allow |
21,102 |
20,420 |
$4.34M |
| B4155 |
Ef incomplete/modular |
4,196 |
3,755 |
$2.08M |
| B9998 |
Enteral supp not otherwise c |
7,013 |
5,268 |
$942K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,493 |
2,317 |
$544K |
| B4161 |
Ef ped hydrolyzed/amino acid |
695 |
625 |
$487K |
| K0554 |
Ther cgm receiver/monitor |
1,201 |
1,163 |
$443K |
| B4104 |
Additive for enteral formula |
976 |
856 |
$400K |
| B4035 |
Enteral feed supp pump per d |
1,392 |
1,309 |
$397K |
| A4253 |
Blood glucose/reagent strips |
10,164 |
6,549 |
$336K |
| T4531 |
Ped size pull-on sm/med |
2,086 |
2,004 |
$296K |
| B4157 |
Ef special metabolic inherit |
334 |
270 |
$241K |
| E2103 |
Non-adju cgm receiver/mon |
656 |
617 |
$139K |
| B4158 |
Ef ped complete intact nut |
614 |
603 |
$69K |
| B4152 |
Ef calorie dense>/=1.5kcal |
325 |
303 |
$67K |
| A4245 |
Alcohol wipes per box |
12,364 |
11,351 |
$55K |
| A4554 |
Disposable underpads |
1,315 |
1,258 |
$44K |
| T1999 |
Noc retail items andsupplies |
476 |
473 |
$17K |
| A4322 |
Irrigation syringe |
1,477 |
1,450 |
$13K |
| A4335 |
Incontinence supply |
1,914 |
1,850 |
$12K |
| A4670 |
Automatic bp monitor, dial |
192 |
172 |
$11K |
| A6216 |
Non-sterile gauze<=16 sq in |
930 |
915 |
$2K |
| A4209 |
5+ cc sterile syringe&needle |
562 |
526 |
$890.26 |