| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
1,593 |
532 |
$133K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
820 |
342 |
$19K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
570 |
394 |
$11K |
| 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 |
13 |
12 |
$521.65 |