| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1569 |
Gammagard liquid injection |
973 |
617 |
$4.39M |
| S9342 |
Hit enteral pump diem |
3,945 |
2,604 |
$1.57M |
| J1561 |
Gamunex-c/gammaked |
157 |
123 |
$661K |
| S9500 |
Hit antibiotic q24h diem |
1,663 |
452 |
$576K |
| 99601 |
|
6,648 |
2,809 |
$575K |
| 99602 |
Nursing care in home rn |
3,204 |
1,765 |
$515K |
| S9338 |
Hit immunotherapy diem |
2,682 |
1,588 |
$277K |
| B4153 |
Ef hydrolyzed/amino acids |
383 |
343 |
$191K |
| B4149 |
Ef blenderized foods |
678 |
573 |
$164K |
| B4035 |
Enteral feed supp pump per d |
1,868 |
1,738 |
$157K |
| B4150 |
Ef complet w/intact nutrient |
1,207 |
1,111 |
$126K |
| B4185 |
Pn soln nos 10 grams lipids |
449 |
144 |
$96K |
| B4161 |
Ef ped hydrolyzed/amino acid |
283 |
247 |
$80K |
| B4152 |
Ef calorie dense>/=1.5kcal |
788 |
667 |
$60K |
| S9343 |
Hit enteral bolus nurs |
218 |
106 |
$42K |
| B4034 |
Enter feed supkit syr by day |
762 |
716 |
$25K |
| S9374 |
Hit hydra 1 liter diem |
81 |
24 |
$18K |
| B4088 |
Gastro/jejuno tube, low-pro |
159 |
157 |
$16K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
55 |
48 |
$7K |
| A4216 |
Sterile water/saline, 10 ml |
743 |
505 |
$3K |
| B4154 |
Ef spec metabolic noninherit |
12 |
12 |
$2K |
| J3490 |
Drugs unclassified injection |
24 |
13 |
$473.57 |
| J1200 |
Diphenhydramine hcl injectio |
22 |
12 |
$90.11 |
| 99080 |
|
70 |
39 |
$0.00 |