| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
8,379 |
3,769 |
$870K |
| B4161 |
Ef ped hydrolyzed/amino acid |
2,188 |
1,273 |
$781K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,602 |
926 |
$211K |
| B9002 |
Enter nutr inf pump any type |
2,863 |
2,150 |
$199K |
| B4034 |
Enter feed supkit syr by day |
3,432 |
1,662 |
$151K |
| A4222 |
Infusion supplies with pump |
1,106 |
544 |
$149K |
| A4221 |
Supp non-insulin inf cath/wk |
3,099 |
1,430 |
$62K |
| E0781 |
External ambulatory infus pu |
253 |
214 |
$61K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,733 |
1,252 |
$54K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,042 |
537 |
$50K |
| E0776 |
Iv pole |
2,105 |
1,549 |
$25K |
| B4149 |
Ef blenderized foods |
73 |
38 |
$11K |
| A6402 |
Sterile gauze <= 16 sq in |
1,943 |
1,278 |
$11K |
| J7030 |
Normal saline solution infus |
1,076 |
397 |
$5K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
160 |
77 |
$2K |
| A4649 |
Surgical supplies |
267 |
125 |
$156.44 |
| A4450 |
Non-waterproof tape |
312 |
153 |
$55.56 |
| A6260 |
Wound cleanser any type/size |
36 |
13 |
$0.00 |