| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,850 |
2,730 |
$581K |
| 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 |
723 |
708 |
$88K |
| 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 |
208 |
201 |
$53K |
| A4554 |
Disposable underpads, all sizes |
802 |
771 |
$50K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
279 |
260 |
$42K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
182 |
171 |
$23K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
61 |
60 |
$8K |
| A4259 |
Lancets, per box of 100 |
286 |
260 |
$4K |
| A4930 |
Gloves, sterile, per pair |
28 |
25 |
$3K |
| E0570 |
Nebulizer, with compressor |
17 |
17 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
80 |
77 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
77 |
76 |
$145.92 |