| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
406 |
94 |
$51K |
| 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 |
601 |
338 |
$40K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
2,956 |
869 |
$39K |
| E0779 |
Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater |
478 |
43 |
$7K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
33 |
12 |
$85.08 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
77 |
25 |
$37.44 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
75 |
25 |
$18.24 |