| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
20,360 |
20,051 |
$5.54M |
| 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 |
7,045 |
6,094 |
$5.22M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
21,102 |
20,420 |
$4.34M |
| 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 |
4,196 |
3,755 |
$2.08M |
| B9998 |
Noc for enteral supplies |
7,013 |
5,268 |
$942K |
| 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 |
2,493 |
2,317 |
$544K |
| 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 |
695 |
625 |
$487K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
1,201 |
1,163 |
$443K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
976 |
856 |
$400K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,392 |
1,309 |
$397K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
10,164 |
6,549 |
$336K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
2,086 |
2,004 |
$296K |
| B4157 |
Enteral formula, nutritionally complete, for 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 |
334 |
270 |
$241K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
656 |
617 |
$139K |
| 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 |
614 |
603 |
$69K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 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 |
325 |
303 |
$67K |
| A4245 |
Alcohol wipes, per box |
12,364 |
11,351 |
$55K |
| A4554 |
Disposable underpads, all sizes |
1,315 |
1,258 |
$44K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
476 |
473 |
$17K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,477 |
1,450 |
$13K |
| A4335 |
Incontinence supply; miscellaneous |
1,914 |
1,850 |
$12K |
| A4670 |
Automatic blood pressure monitor |
192 |
172 |
$11K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
930 |
915 |
$2K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
562 |
526 |
$890.26 |