| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,148 |
1,047 |
$34K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,599 |
1,254 |
$25K |
| B9002 |
Enteral nutrition infusion pump, any type |
168 |
165 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,357 |
1,214 |
$1K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,270 |
1,142 |
$1K |
| E0776 |
Iv pole |
916 |
914 |
$972.46 |
| A7526 |
Tracheostomy tube collar/holder, each |
250 |
236 |
$456.64 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
210 |
198 |
$388.64 |
| A4623 |
Tracheostomy, inner cannula |
138 |
128 |
$183.12 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
13 |
13 |
$3.90 |