| 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 |
528 |
484 |
$145K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
321 |
293 |
$61K |
| B9998 |
Noc for enteral supplies |
126 |
75 |
$14K |
| B4083 |
Stomach tube - levine type |
300 |
277 |
$6K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
38 |
38 |
$3K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
35 |
27 |
$842.52 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
35 |
27 |
$83.93 |