| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
599 |
462 |
$196K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,094 |
834 |
$130K |
| B4035 |
Enteral feed supp pump per d |
1,762 |
1,358 |
$113K |
| B9998 |
Enteral supp not otherwise c |
1,432 |
1,101 |
$68K |
| B4100 |
Food thickener oral |
494 |
381 |
$53K |
| B4149 |
Ef blenderized foods |
94 |
68 |
$37K |
| B4152 |
Ef calorie dense>/=1.5kcal |
182 |
145 |
$21K |
| B4150 |
Ef complet w/intact nutrient |
139 |
111 |
$13K |
| B4155 |
Ef incomplete/modular |
401 |
320 |
$9K |
| B4154 |
Ef spec metabolic noninherit |
32 |
28 |
$7K |
| A4221 |
Supp non-insulin inf cath/wk |
169 |
56 |
$3K |
| Q0513 |
Disp fee inhal drugs/30 days |
406 |
285 |
$2K |
| A4322 |
Irrigation syringe |
141 |
125 |
$1K |
| B4034 |
Enter feed supkit syr by day |
91 |
70 |
$264.71 |
| J7620 |
Albuterol ipratrop non-comp |
39 |
26 |
$45.41 |
| J7613 |
Albuterol non-comp unit |
32 |
26 |
$13.38 |
| M0239 |
Bamlanivimab-xxxx infusion |
19 |
13 |
$0.00 |
| M0244 |
Casirivi and imdevi inj hm |
15 |
14 |
$0.00 |