| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
440 |
371 |
$218K |
| B4035 |
Enteral feed supp pump per d |
963 |
878 |
$204K |
| B4087 |
Gastro/jejuno tube, std |
1,320 |
813 |
$107K |
| B4149 |
Ef blenderized foods |
432 |
250 |
$98K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
521 |
348 |
$54K |
| B4034 |
Enter feed supkit syr by day |
395 |
349 |
$45K |
| B4152 |
Ef calorie dense>/=1.5kcal |
195 |
148 |
$31K |
| B4153 |
Ef hydrolyzed/amino acids |
66 |
50 |
$29K |
| B4185 |
Pn soln nos 10 grams lipids |
105 |
25 |
$14K |
| B4088 |
Gastro/jejuno tube, low-pro |
180 |
170 |
$13K |
| B4150 |
Ef complet w/intact nutrient |
93 |
68 |
$11K |
| B4154 |
Ef spec metabolic noninherit |
34 |
29 |
$11K |
| B4224 |
Parenteral administration ki |
106 |
27 |
$10K |
| B9998 |
Enteral supp not otherwise c |
56 |
52 |
$9K |
| 97803 |
|
162 |
135 |
$7K |
| B4100 |
Food thickener oral |
104 |
104 |
$7K |
| A4222 |
Infusion supplies with pump |
31 |
15 |
$5K |
| B9002 |
Enter nutr inf pump any type |
68 |
66 |
$5K |
| 97802 |
|
65 |
65 |
$4K |
| B4220 |
Parenteral supply kit premix |
103 |
27 |
$3K |
| B4155 |
Ef incomplete/modular |
52 |
42 |
$3K |
| B4158 |
Ef ped complete intact nut |
36 |
34 |
$3K |
| E1390 |
Oxygen concentrator |
22 |
18 |
$2K |
| A4221 |
Supp non-insulin inf cath/wk |
34 |
16 |
$619.20 |