| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
21,431 |
18,709 |
$11.89M |
| B4035 |
Enteral feed supp pump per d |
35,533 |
24,902 |
$7.43M |
| B4149 |
Ef blenderized foods |
9,849 |
7,121 |
$2.96M |
| A4222 |
Infusion supplies with pump |
13,188 |
6,528 |
$2.90M |
| B4087 |
Gastro/jejuno tube, std |
22,291 |
18,227 |
$2.86M |
| J1745 |
Infliximab not biosimil 10mg |
1,402 |
1,169 |
$2.82M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
13,551 |
11,457 |
$1.64M |
| B4153 |
Ef hydrolyzed/amino acids |
3,209 |
2,765 |
$1.62M |
| A4223 |
Infusion supplies w/o pump |
3,658 |
1,843 |
$868K |
| B4150 |
Ef complet w/intact nutrient |
5,951 |
5,061 |
$812K |
| B4034 |
Enter feed supkit syr by day |
7,911 |
5,794 |
$774K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,105 |
3,435 |
$696K |
| B4088 |
Gastro/jejuno tube, low-pro |
7,514 |
7,078 |
$546K |
| B4154 |
Ef spec metabolic noninherit |
1,692 |
1,466 |
$514K |
| B9002 |
Enter nutr inf pump any type |
5,136 |
4,919 |
$511K |
| B4185 |
Pn soln nos 10 grams lipids |
1,406 |
374 |
$343K |
| 99601 |
|
3,265 |
1,662 |
$340K |
| E0781 |
External ambulatory infus pu |
1,318 |
1,284 |
$338K |
| A4221 |
Supp non-insulin inf cath/wk |
12,774 |
7,489 |
$319K |
| B4224 |
Parenteral administration ki |
2,008 |
507 |
$313K |
| B4036 |
Enteral feed sup kit grav by |
2,085 |
1,692 |
$285K |
| B4100 |
Food thickener oral |
3,597 |
3,311 |
$210K |
| 97803 |
|
3,709 |
2,915 |
$144K |
| B4155 |
Ef incomplete/modular |
2,648 |
2,280 |
$135K |
| B4158 |
Ef ped complete intact nut |
1,072 |
963 |
$122K |
| B4220 |
Parenteral supply kit premix |
2,003 |
507 |
$100K |
| B4103 |
Ef ped fluid and electrolyte |
561 |
496 |
$84K |
| B4082 |
Enteral ng tubing w/o stylet |
2,418 |
1,549 |
$75K |
| 99602 |
Nursing care in home rn |
1,357 |
871 |
$70K |
| B4189 |
Parenteral sol amino acid & |
52 |
12 |
$56K |
| J3475 |
Inj magnesium sulfate |
624 |
167 |
$11K |
| 97802 |
|
159 |
150 |
$6K |
| J2997 |
Alteplase recombinant |
12 |
12 |
$3K |
| J3370 |
Vancomycin hcl injection |
55 |
12 |
$3K |
| E0776 |
Iv pole |
13 |
13 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
28 |
12 |
$930.78 |
| J1200 |
Diphenhydramine hcl injectio |
17 |
14 |
$107.83 |