| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,286 |
720 |
$21K |
| B9998 |
Noc for enteral supplies |
330 |
283 |
$17K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
139 |
125 |
$15K |
| 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 |
841 |
721 |
$15K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,363 |
1,273 |
$14K |
| 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 |
1,815 |
1,494 |
$9K |
| J3490 |
Unclassified drugs |
424 |
102 |
$8K |
| B9002 |
Enteral nutrition infusion pump, any type |
103 |
99 |
$5K |
| 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 |
536 |
343 |
$5K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,219 |
1,219 |
$3K |
| A4322 |
Irrigation syringe, bulb or piston, each |
158 |
137 |
$2K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
38 |
12 |
$1K |