| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
274 |
81 |
$6K |
| 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 |
83 |
38 |
$3K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
16 |
13 |
$1K |
| 99601 |
|
47 |
12 |
$800.00 |
| K0001 |
Standard wheelchair |
24 |
24 |
$456.21 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
15 |
13 |
$439.94 |