| 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 |
8,379 |
3,769 |
$870K |
| 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 |
2,188 |
1,273 |
$781K |
| 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 |
1,602 |
926 |
$211K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,863 |
2,150 |
$199K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,432 |
1,662 |
$151K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
1,106 |
544 |
$149K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
3,099 |
1,430 |
$62K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
253 |
214 |
$61K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,733 |
1,252 |
$54K |
| 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 |
1,042 |
537 |
$50K |
| E0776 |
Iv pole |
2,105 |
1,549 |
$25K |
| 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 |
73 |
38 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,943 |
1,278 |
$11K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
1,076 |
397 |
$5K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
160 |
77 |
$2K |
| A4649 |
Surgical supply; miscellaneous |
267 |
125 |
$156.44 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
312 |
153 |
$55.56 |
| A6260 |
Wound cleansers, any type, any size |
36 |
13 |
$0.00 |