| 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 |
36,468 |
25,296 |
$5.62M |
| 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 |
15,404 |
12,780 |
$1.26M |
| A4554 |
Disposable underpads, all sizes |
14,970 |
11,493 |
$654K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,570 |
3,885 |
$511K |
| 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 |
5,622 |
3,926 |
$501K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,775 |
3,182 |
$387K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,898 |
2,353 |
$373K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,748 |
2,202 |
$284K |
| 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 |
2,645 |
1,961 |
$281K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,677 |
1,386 |
$199K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,071 |
1,522 |
$195K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15,151 |
1,132 |
$187K |
| A4927 |
Gloves, non-sterile, per 100 |
6,135 |
4,540 |
$117K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
926 |
501 |
$52K |
| E0601 |
Continuous positive airway pressure (cpap) device |
402 |
246 |
$15K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
463 |
215 |
$11K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
97 |
64 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
377 |
216 |
$4K |
| K0001 |
Standard wheelchair |
280 |
135 |
$2K |
| B9998 |
Noc for enteral supplies |
257 |
137 |
$2K |