| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
2,277 |
1,445 |
$609K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,285 |
2,847 |
$501K |
| B4035 |
Enteral feed supp pump per d |
7,176 |
4,609 |
$431K |
| B4150 |
Ef complet w/intact nutrient |
2,262 |
1,323 |
$252K |
| B4100 |
Food thickener oral |
2,320 |
1,663 |
$234K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,186 |
1,386 |
$228K |
| B4149 |
Ef blenderized foods |
885 |
509 |
$227K |
| B9998 |
Enteral supp not otherwise c |
3,517 |
2,322 |
$80K |
| A4213 |
20+ cc syringe only |
561 |
412 |
$67K |
| A4221 |
Supp non-insulin inf cath/wk |
5,287 |
1,556 |
$51K |
| B4220 |
Parenteral supply kit premix |
139 |
25 |
$47K |
| B4155 |
Ef incomplete/modular |
1,211 |
711 |
$33K |
| A4222 |
Infusion supplies with pump |
237 |
78 |
$8K |
| B9002 |
Enter nutr inf pump any type |
280 |
184 |
$6K |
| B4034 |
Enter feed supkit syr by day |
291 |
176 |
$2K |
| A4322 |
Irrigation syringe |
13 |
12 |
$128.32 |
| A4216 |
Sterile water/saline, 10 ml |
121 |
59 |
$0.00 |
| J1642 |
Inj heparin sodium per 10 u |
94 |
44 |
$0.00 |