| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
251 |
191 |
$42K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
289 |
168 |
$31K |
| 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 |
77 |
43 |
$31K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
1,195 |
362 |
$17K |
| 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 |
170 |
70 |
$9K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
121 |
85 |
$6K |
| B9002 |
Enteral nutrition infusion pump, any type |
101 |
70 |
$5K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
60 |
41 |
$4K |
| B9998 |
Noc for enteral supplies |
101 |
82 |
$3K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
44 |
12 |
$425.50 |
| E0776 |
Iv pole |
100 |
69 |
$384.00 |
| 0064A |
|
268 |
268 |
$0.00 |
| 0012A |
|
133 |
133 |
$0.00 |
| 0011A |
|
119 |
119 |
$0.00 |
| 0013A |
|
501 |
501 |
$0.00 |
| 0124A |
|
486 |
486 |
$0.00 |