| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
13,165 |
11,570 |
$1.93M |
| B4149 |
Ef blenderized foods |
4,738 |
4,266 |
$1.87M |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,153 |
2,767 |
$1.18M |
| B4088 |
Gastro/jejuno tube, low-pro |
7,379 |
6,269 |
$655K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,007 |
3,433 |
$566K |
| T1999 |
Noc retail items andsupplies |
32,420 |
4,241 |
$399K |
| B9002 |
Enter nutr inf pump any type |
5,642 |
4,847 |
$331K |
| B4153 |
Ef hydrolyzed/amino acids |
462 |
414 |
$211K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,142 |
889 |
$191K |
| B4150 |
Ef complet w/intact nutrient |
922 |
775 |
$158K |
| B4034 |
Enter feed supkit syr by day |
3,187 |
2,472 |
$144K |
| B4036 |
Enteral feed sup kit grav by |
1,367 |
1,141 |
$135K |
| E0781 |
External ambulatory infus pu |
2,222 |
857 |
$114K |
| B4154 |
Ef spec metabolic noninherit |
140 |
117 |
$39K |
| B4155 |
Ef incomplete/modular |
774 |
714 |
$22K |
| A4927 |
Non-sterile gloves |
2,723 |
2,013 |
$21K |
| A4216 |
Sterile water/saline, 10 ml |
9,556 |
3,460 |
$15K |
| S1015 |
Iv tubing extension set |
1,928 |
706 |
$14K |
| B4158 |
Ef ped complete intact nut |
164 |
145 |
$13K |
| A4322 |
Irrigation syringe |
352 |
318 |
$10K |
| E0776 |
Iv pole |
177 |
141 |
$9K |
| A4213 |
20+ cc syringe only |
1,282 |
746 |
$7K |
| A6258 |
Transparent film >16<=48 in |
371 |
135 |
$3K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
202 |
87 |
$2K |
| A4452 |
Waterproof tape |
1,103 |
896 |
$2K |
| A4450 |
Non-waterproof tape |
648 |
517 |
$1K |
| A4209 |
5+ cc sterile syringe&needle |
462 |
172 |
$650.49 |
| A6257 |
Transparent film <= 16 sq in |
240 |
111 |
$521.09 |
| 0003A |
|
21 |
13 |
$496.08 |
| A6402 |
Sterile gauze <= 16 sq in |
25 |
25 |
$305.70 |
| A4657 |
Syringe w/wo needle |
92 |
30 |
$40.28 |
| 91300 |
|
14 |
12 |
$0.00 |