| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9340 |
Hit enteral per diem |
639 |
469 |
$468K |
| S9500 |
Hit antibiotic q24h diem |
734 |
239 |
$329K |
| 99601 |
|
2,651 |
867 |
$256K |
| A4223 |
Infusion supplies w/o pump |
2,472 |
994 |
$219K |
| J1726 |
Makena, 10 mg |
186 |
64 |
$196K |
| B4153 |
Ef hydrolyzed/amino acids |
749 |
372 |
$160K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,625 |
1,197 |
$156K |
| B4035 |
Enteral feed supp pump per d |
1,474 |
939 |
$111K |
| A4222 |
Infusion supplies with pump |
994 |
256 |
$62K |
| B4150 |
Ef complet w/intact nutrient |
1,117 |
566 |
$57K |
| B4034 |
Enter feed supkit syr by day |
1,549 |
872 |
$43K |
| J3370 |
Vancomycin hcl injection |
133 |
38 |
$28K |
| B4185 |
Pn soln nos 10 grams lipids |
178 |
37 |
$21K |
| S9501 |
Hit antibiotic q12h diem |
27 |
13 |
$13K |
| A4305 |
Drug delivery system >=50 ml |
686 |
62 |
$9K |
| A4221 |
Supp non-insulin inf cath/wk |
494 |
224 |
$8K |
| B4161 |
Ef ped hydrolyzed/amino acid |
21 |
12 |
$7K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
57 |
33 |
$4K |
| S9542 |
Ht inj noc per diem |
59 |
24 |
$2K |
| A4209 |
5+ cc sterile syringe&needle |
149 |
104 |
$1K |
| B4155 |
Ef incomplete/modular |
33 |
24 |
$1K |
| S9560 |
Ht inj hormone diem |
15 |
14 |
$960.00 |
| A4930 |
Sterile, gloves per pair |
163 |
97 |
$457.05 |
| A6257 |
Transparent film <= 16 sq in |
163 |
98 |
$359.70 |
| J7030 |
Normal saline solution infus |
79 |
39 |
$315.93 |
| A4216 |
Sterile water/saline, 10 ml |
59 |
31 |
$137.72 |
| A4322 |
Irrigation syringe |
13 |
12 |
$73.60 |