| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
7,433 |
5,295 |
$3.68M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
42,583 |
11,698 |
$2.51M |
| 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 |
11,421 |
7,407 |
$1.33M |
| 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 |
3,177 |
2,474 |
$1.14M |
| B4100 |
Food thickener, administered orally, per ounce |
9,623 |
7,251 |
$755K |
| B9998 |
Noc for enteral supplies |
14,756 |
8,295 |
$700K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,232 |
5,632 |
$669K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,415 |
4,887 |
$588K |
| E0570 |
Nebulizer, with compressor |
4,091 |
3,793 |
$500K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12,343 |
3,266 |
$452K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,869 |
3,537 |
$339K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,876 |
6,484 |
$265K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
2,726 |
2,441 |
$256K |
| 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 |
1,748 |
1,289 |
$233K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
415 |
267 |
$228K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,457 |
1,142 |
$132K |
| 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 |
2,939 |
2,402 |
$129K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,115 |
913 |
$102K |
| 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 |
578 |
485 |
$92K |
| A4927 |
Gloves, non-sterile, per 100 |
7,484 |
6,898 |
$90K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
2,306 |
1,142 |
$51K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
154 |
125 |
$49K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
435 |
423 |
$49K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
459 |
435 |
$49K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,276 |
1,125 |
$46K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
303 |
287 |
$27K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
194 |
148 |
$19K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
8,655 |
4,145 |
$18K |
| E0776 |
Iv pole |
232 |
202 |
$16K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
74 |
50 |
$14K |
| A7015 |
Aerosol mask, used with dme nebulizer |
8,694 |
4,161 |
$14K |
| G0299 |
Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
124 |
35 |
$5K |
| E0605 |
Vaporizer, room type |
240 |
232 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
31 |
28 |
$3K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
28 |
25 |
$2K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
147 |
116 |
$967.61 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
56 |
53 |
$282.40 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
23 |
23 |
$46.67 |