| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
7,265 |
3,376 |
$5.01M |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
591 |
567 |
$1.66M |
| J3380 |
Injection, vedolizumab, intravenous, 1 mg |
162 |
148 |
$1.04M |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
4,962 |
2,715 |
$582K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,201 |
2,682 |
$521K |
| 99601 |
|
4,426 |
2,277 |
$511K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
11,588 |
6,432 |
$243K |
| 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 |
1,382 |
1,147 |
$136K |
| 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 |
1,278 |
1,119 |
$126K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,282 |
933 |
$94K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
352 |
92 |
$75K |
| B4224 |
Parenteral nutrition administration kit, per day |
341 |
89 |
$40K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
74 |
61 |
$22K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
394 |
101 |
$15K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
123 |
120 |
$8K |
| B9002 |
Enteral nutrition infusion pump, any type |
83 |
81 |
$7K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
13 |
12 |
$4K |
| E0776 |
Iv pole |
29 |
27 |
$3K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
16 |
13 |
$189.64 |
| 99072 |
|
54 |
40 |
$0.00 |