| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
2,991 |
2,475 |
$77K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,917 |
1,539 |
$49K |
| B4154 |
Ef spec metabolic noninherit |
1,031 |
860 |
$47K |
| B4150 |
Ef complet w/intact nutrient |
1,178 |
977 |
$31K |
| B4034 |
Enter feed supkit syr by day |
916 |
765 |
$13K |
| B9002 |
Enter nutr inf pump any type |
785 |
713 |
$9K |
| A6212 |
Foam drg <=16 sq in w/border |
296 |
284 |
$3K |
| E0776 |
Iv pole |
2,181 |
1,905 |
$2K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
241 |
220 |
$2K |
| A6197 |
Alginate drsg >16 <=48 sq in |
72 |
68 |
$2K |
| B4036 |
Enteral feed sup kit grav by |
78 |
63 |
$2K |
| A4338 |
Indwelling catheter latex |
855 |
791 |
$1K |
| B4153 |
Ef hydrolyzed/amino acids |
12 |
12 |
$817.68 |
| A6402 |
Sterile gauze <= 16 sq in |
799 |
750 |
$812.59 |
| A4357 |
Bedside drainage bag |
835 |
758 |
$731.12 |
| A5063 |
Drain ostomy pouch w/flange |
375 |
342 |
$713.66 |
| A4310 |
Insert tray w/o bag/cath |
713 |
649 |
$399.43 |
| A6196 |
Alginate dressing <=16 sq in |
81 |
79 |
$378.66 |
| B4087 |
Gastro/jejuno tube, std |
76 |
73 |
$358.21 |
| A4314 |
Cath w/drainage 2-way latex |
159 |
148 |
$324.59 |
| B4155 |
Ef incomplete/modular |
52 |
51 |
$316.03 |
| A6254 |
Absorpt drg <=16 sq in w/bdr |
39 |
38 |
$93.92 |
| A6447 |
Conform band s w >=5"/yd |
81 |
76 |
$5.40 |