| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
74,942 |
61,088 |
$20.26M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
173,836 |
147,560 |
$16.37M |
| B4035 |
Enteral feed supp pump per d |
141,232 |
102,260 |
$14.74M |
| B9998 |
Enteral supp not otherwise c |
63,136 |
49,756 |
$3.24M |
| B4149 |
Ef blenderized foods |
23,070 |
19,377 |
$2.95M |
| B4158 |
Ef ped complete intact nut |
17,599 |
14,282 |
$2.52M |
| B4152 |
Ef calorie dense>/=1.5kcal |
28,522 |
24,035 |
$2.45M |
| B9002 |
Enter nutr inf pump any type |
62,534 |
52,649 |
$2.22M |
| B4150 |
Ef complet w/intact nutrient |
34,293 |
29,359 |
$2.01M |
| B4153 |
Ef hydrolyzed/amino acids |
7,862 |
6,700 |
$1.77M |
| B4088 |
Gastro/jejuno tube, low-pro |
37,682 |
33,774 |
$1.37M |
| B4154 |
Ef spec metabolic noninherit |
10,680 |
8,766 |
$1.28M |
| B4034 |
Enter feed supkit syr by day |
25,917 |
19,848 |
$1.27M |
| B4155 |
Ef incomplete/modular |
26,526 |
22,629 |
$1.17M |
| B4103 |
Ef ped fluid and electrolyte |
19,726 |
17,044 |
$999K |
| B4162 |
Ef ped specmetabolic inherit |
2,160 |
1,747 |
$818K |
| B4100 |
Food thickener oral |
12,529 |
10,546 |
$591K |
| T4530 |
Ped size brief/diaper lg |
5,253 |
4,610 |
$408K |
| T4534 |
Youth size pull-on |
4,082 |
3,495 |
$388K |
| B4036 |
Enteral feed sup kit grav by |
4,647 |
3,578 |
$367K |
| A4554 |
Disposable underpads |
9,334 |
7,932 |
$334K |
| E0776 |
Iv pole |
45,373 |
41,220 |
$317K |
| B4081 |
Enteral ng tubing w/ stylet |
9,168 |
7,391 |
$287K |
| A9999 |
Dme supply or accessory, nos |
3,052 |
1,720 |
$240K |
| T4522 |
Adult size brief/diaper med |
1,717 |
1,445 |
$150K |
| T4532 |
Ped size pull-on lg |
1,427 |
1,228 |
$119K |
| B4082 |
Enteral ng tubing w/o stylet |
3,394 |
2,735 |
$100K |
| B4104 |
Additive for enteral formula |
4,186 |
3,685 |
$76K |
| T4521 |
Adult size brief/diaper sm |
788 |
665 |
$67K |
| A4335 |
Incontinence supply |
13,047 |
11,340 |
$62K |
| T4541 |
Large disposable underpad |
1,075 |
1,007 |
$33K |
| A4927 |
Non-sterile gloves |
2,284 |
1,867 |
$29K |
| T4526 |
Adult size pull-on med |
405 |
330 |
$27K |
| B4102 |
Ef adult fluids and electro |
823 |
682 |
$26K |
| T4523 |
Adult size brief/diaper lg |
196 |
165 |
$24K |
| B4157 |
Ef special metabolic inherit |
54 |
37 |
$23K |
| T4525 |
Adult size pull-on sm |
218 |
196 |
$22K |
| A4385 |
Ost skn barrier sld ext wear |
251 |
173 |
$17K |
| E1399 |
Durable medical equipment mi |
42 |
38 |
$16K |
| B4087 |
Gastro/jejuno tube, std |
628 |
538 |
$11K |
| W4211 |
|
2,428 |
2,031 |
$4K |
| A4371 |
Skin barrier powder per oz |
242 |
174 |
$1K |
| A4456 |
Adhesive remover, wipes |
202 |
135 |
$1K |
| A4351 |
Straight tip urine catheter |
14 |
12 |
$950.82 |
| W4212 |
|
201 |
171 |
$192.60 |
| A5120 |
Skin barrier, wipe or swab |
35 |
24 |
$78.75 |
| A4322 |
Irrigation syringe |
15 |
13 |
$72.72 |
| A6257 |
Transparent film <= 16 sq in |
173 |
169 |
$37.34 |
| 84160 |
|
201 |
194 |
$0.00 |
| 84150 |
|
12 |
12 |
$0.00 |
| 84035 |
|
265 |
254 |
$0.00 |
| 84155 |
|
12 |
12 |
$0.00 |
| A4452 |
Waterproof tape |
128 |
127 |
$0.00 |