| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
50,654 |
45,422 |
$2.58M |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,798 |
2,434 |
$1.26M |
| 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 |
26,342 |
24,701 |
$1.16M |
| 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 |
14,086 |
13,156 |
$1.15M |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
6,006 |
4,527 |
$1.03M |
| 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 |
4,801 |
4,345 |
$715K |
| 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 |
14,417 |
13,061 |
$659K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13,025 |
12,435 |
$358K |
| B4100 |
Food thickener, administered orally, per ounce |
4,672 |
3,590 |
$339K |
| B9998 |
Noc for enteral supplies |
8,855 |
6,952 |
$209K |
| B9002 |
Enteral nutrition infusion pump, any type |
10,480 |
9,879 |
$161K |
| A4554 |
Disposable underpads, all sizes |
1,787 |
1,727 |
$153K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,630 |
1,347 |
$102K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
4,725 |
3,603 |
$96K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,808 |
1,652 |
$86K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
290 |
181 |
$78K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
772 |
684 |
$68K |
| E0776 |
Iv pole |
9,444 |
9,311 |
$26K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
320 |
246 |
$22K |
| A4335 |
Incontinence supply; miscellaneous |
2,275 |
2,213 |
$20K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,795 |
3,651 |
$11K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
476 |
454 |
$10K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
3,596 |
3,483 |
$9K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
396 |
381 |
$8K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
323 |
298 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
177 |
156 |
$4K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
494 |
442 |
$3K |
| A4623 |
Tracheostomy, inner cannula |
169 |
141 |
$2K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
210 |
210 |
$2K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
14 |
13 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
97 |
90 |
$1K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13 |
12 |
$1K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
28 |
25 |
$177.52 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
33 |
30 |
$166.74 |