| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13,165 |
11,570 |
$1.93M |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
4,738 |
4,266 |
$1.87M |
| 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 |
3,153 |
2,767 |
$1.18M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
7,379 |
6,269 |
$655K |
| 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 |
4,007 |
3,433 |
$566K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
32,420 |
4,241 |
$399K |
| B9002 |
Enteral nutrition infusion pump, any type |
5,642 |
4,847 |
$331K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
462 |
414 |
$211K |
| 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 |
1,142 |
889 |
$191K |
| 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 |
922 |
775 |
$158K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,187 |
2,472 |
$144K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,367 |
1,141 |
$135K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
2,222 |
857 |
$114K |
| 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 |
140 |
117 |
$39K |
| 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 |
774 |
714 |
$22K |
| A4927 |
Gloves, non-sterile, per 100 |
2,723 |
2,013 |
$21K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
9,556 |
3,460 |
$15K |
| S1015 |
Iv tubing extension set |
1,928 |
706 |
$14K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
164 |
145 |
$13K |
| A4322 |
Irrigation syringe, bulb or piston, each |
352 |
318 |
$10K |
| E0776 |
Iv pole |
177 |
141 |
$9K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,282 |
746 |
$7K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
371 |
135 |
$3K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
202 |
87 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,103 |
896 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
648 |
517 |
$1K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
462 |
172 |
$650.49 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
240 |
111 |
$521.09 |
| 0003A |
|
21 |
13 |
$496.08 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
25 |
25 |
$305.70 |
| A4657 |
Syringe, with or without needle, each |
92 |
30 |
$40.28 |
| 91300 |
|
14 |
12 |
$0.00 |