| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
7,898 |
5,731 |
$598K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,673 |
1,568 |
$568K |
| B4161 |
Ef ped hydrolyzed/amino acid |
861 |
794 |
$448K |
| B4149 |
Ef blenderized foods |
1,410 |
876 |
$427K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
991 |
583 |
$225K |
| B4150 |
Ef complet w/intact nutrient |
774 |
637 |
$188K |
| A4216 |
Sterile water/saline, 10 ml |
2,266 |
1,445 |
$166K |
| B9002 |
Enter nutr inf pump any type |
5,738 |
5,088 |
$98K |
| B9998 |
Enteral supp not otherwise c |
607 |
561 |
$64K |
| B4034 |
Enter feed supkit syr by day |
1,954 |
1,289 |
$63K |
| A4221 |
Supp non-insulin inf cath/wk |
3,846 |
2,151 |
$62K |
| B4155 |
Ef incomplete/modular |
71 |
68 |
$25K |
| A6402 |
Sterile gauze <= 16 sq in |
220 |
202 |
$21K |
| J7030 |
Normal saline solution infus |
334 |
202 |
$16K |
| B4081 |
Enteral ng tubing w/ stylet |
210 |
168 |
$15K |
| E0776 |
Iv pole |
1,790 |
1,575 |
$10K |
| B4088 |
Gastro/jejuno tube, low-pro |
98 |
95 |
$7K |
| S1015 |
Iv tubing extension set |
564 |
292 |
$5K |
| A6257 |
Transparent film <= 16 sq in |
19 |
14 |
$3K |
| A4210 |
Nonneedle injection device |
71 |
28 |
$1K |
| M0243 |
Casirivi and imdevi inj |
40 |
36 |
$900.00 |
| A4452 |
Waterproof tape |
17 |
16 |
$370.65 |
| 90713 |
|
20 |
20 |
$358.99 |
| 90633 |
|
13 |
13 |
$124.29 |
| A4212 |
Non coring needle or stylet |
17 |
12 |
$40.71 |
| 90715 |
|
16 |
15 |
$13.81 |
| 90471 |
|
36 |
35 |
$13.81 |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
13 |
12 |
$4.64 |
| 90472 |
|
22 |
21 |
$0.00 |
| A4215 |
Sterile needle |
28 |
12 |
$0.00 |
| A4213 |
20+ cc syringe only |
17 |
12 |
$0.00 |