| 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 |
15,174 |
13,034 |
$7.31M |
| 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 |
38,420 |
33,515 |
$4.18M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
35,909 |
14,542 |
$3.80M |
| 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 |
9,141 |
6,627 |
$2.72M |
| A4554 |
Disposable underpads, all sizes |
26,035 |
24,673 |
$1.40M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
10,984 |
9,824 |
$1.37M |
| 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 |
11,545 |
9,328 |
$1.21M |
| 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 |
5,767 |
5,320 |
$960K |
| 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 |
7,391 |
5,399 |
$949K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
8,662 |
7,921 |
$838K |
| 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 |
1,510 |
1,151 |
$823K |
| 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 |
3,965 |
3,232 |
$780K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
8,238 |
7,588 |
$699K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
6,254 |
5,801 |
$673K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
11,308 |
5,648 |
$657K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,220 |
4,845 |
$613K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,328 |
5,072 |
$593K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,400 |
4,076 |
$567K |
| A4927 |
Gloves, non-sterile, per 100 |
19,691 |
18,819 |
$507K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,149 |
1,045 |
$496K |
| B4100 |
Food thickener, administered orally, per ounce |
7,826 |
7,163 |
$476K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,510 |
3,343 |
$436K |
| B9998 |
Noc for enteral supplies |
21,989 |
18,916 |
$416K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,960 |
3,244 |
$402K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,017 |
1,823 |
$245K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
1,813 |
914 |
$210K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,843 |
1,771 |
$208K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,963 |
1,726 |
$185K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
4,561 |
4,266 |
$166K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,659 |
1,480 |
$152K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,502 |
2,916 |
$116K |
| A4670 |
Automatic blood pressure monitor |
1,055 |
975 |
$63K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,281 |
1,242 |
$51K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
242 |
234 |
$35K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
50 |
47 |
$34K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
183 |
163 |
$32K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,606 |
1,556 |
$14K |
| A7002 |
Tubing, used with suction pump, each |
1,682 |
1,635 |
$10K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
57 |
50 |
$7K |
| A4335 |
Incontinence supply; miscellaneous |
482 |
443 |
$6K |
| W4211 |
|
172 |
157 |
$3K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
33 |
24 |
$3K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
13 |
12 |
$3K |
| E1639 |
Scale, each |
18 |
18 |
$1K |
| E0570 |
Nebulizer, with compressor |
13 |
12 |
$834.43 |
| E0776 |
Iv pole |
13 |
12 |
$792.00 |
| W4212 |
|
36 |
36 |
$720.18 |
| A7015 |
Aerosol mask, used with dme nebulizer |
266 |
99 |
$678.75 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
165 |
146 |
$382.03 |