| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,898 |
5,731 |
$598K |
| 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 |
2,673 |
1,568 |
$568K |
| 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 |
861 |
794 |
$448K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,410 |
876 |
$427K |
| 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 |
991 |
583 |
$225K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
774 |
637 |
$188K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,266 |
1,445 |
$166K |
| B9002 |
Enteral nutrition infusion pump, any type |
5,738 |
5,088 |
$98K |
| B9998 |
Noc for enteral supplies |
607 |
561 |
$64K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,954 |
1,289 |
$63K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
3,846 |
2,151 |
$62K |
| 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 |
71 |
68 |
$25K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
220 |
202 |
$21K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
334 |
202 |
$16K |
| B4081 |
Nasogastric tubing with stylet |
210 |
168 |
$15K |
| E0776 |
Iv pole |
1,790 |
1,575 |
$10K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
98 |
95 |
$7K |
| S1015 |
Iv tubing extension set |
564 |
292 |
$5K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
19 |
14 |
$3K |
| A4210 |
Needle-free injection device, each |
71 |
28 |
$1K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
40 |
36 |
$900.00 |
| A4452 |
Tape, waterproof, per 18 square inches |
17 |
16 |
$370.65 |
| 90713 |
|
20 |
20 |
$358.99 |
| 90633 |
|
13 |
13 |
$124.29 |
| A4212 |
Non-coring needle or stylet with or without catheter |
17 |
12 |
$40.71 |
| 90715 |
|
16 |
15 |
$13.81 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
36 |
35 |
$13.81 |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
12 |
$4.64 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
22 |
21 |
$0.00 |
| A4215 |
Needle, sterile, any size, each |
28 |
12 |
$0.00 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
17 |
12 |
$0.00 |