| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
1,634 |
1,120 |
$549K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,558 |
1,188 |
$256K |
| B4035 |
Enteral feed supp pump per d |
2,903 |
2,001 |
$208K |
| A4213 |
20+ cc syringe only |
971 |
863 |
$185K |
| B4152 |
Ef calorie dense>/=1.5kcal |
469 |
357 |
$76K |
| J1642 |
Inj heparin sodium per 10 u |
168 |
63 |
$65K |
| B4150 |
Ef complet w/intact nutrient |
549 |
401 |
$63K |
| B9998 |
Enteral supp not otherwise c |
2,682 |
1,764 |
$54K |
| A4222 |
Infusion supplies with pump |
162 |
87 |
$41K |
| B4154 |
Ef spec metabolic noninherit |
90 |
63 |
$40K |
| B4153 |
Ef hydrolyzed/amino acids |
43 |
37 |
$37K |
| B4155 |
Ef incomplete/modular |
793 |
521 |
$25K |
| B4100 |
Food thickener oral |
434 |
356 |
$23K |
| B9002 |
Enter nutr inf pump any type |
697 |
453 |
$22K |
| A4221 |
Supp non-insulin inf cath/wk |
449 |
216 |
$10K |
| E0776 |
Iv pole |
105 |
88 |
$6K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
350 |
114 |
$2K |