| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,277 |
1,445 |
$609K |
| 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 |
4,285 |
2,847 |
$501K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,176 |
4,609 |
$431K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,262 |
1,323 |
$252K |
| B4100 |
Food thickener, administered orally, per ounce |
2,320 |
1,663 |
$234K |
| 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 |
2,186 |
1,386 |
$228K |
| 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 |
885 |
509 |
$227K |
| B9998 |
Noc for enteral supplies |
3,517 |
2,322 |
$80K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
561 |
412 |
$67K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
5,287 |
1,556 |
$51K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
139 |
25 |
$47K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
1,211 |
711 |
$33K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
237 |
78 |
$8K |
| B9002 |
Enteral nutrition infusion pump, any type |
280 |
184 |
$6K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
291 |
176 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
13 |
12 |
$128.32 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
121 |
59 |
$0.00 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
94 |
44 |
$0.00 |