| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J0135 |
Injection, adalimumab, 20 mg |
109 |
104 |
$388K |
| A4215 |
Needle, sterile, any size, each |
4,280 |
4,025 |
$266K |
| J3590 |
Unclassified biologics |
315 |
303 |
$147K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
948 |
797 |
$92K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
384 |
311 |
$53K |
| B9998 |
Noc for enteral supplies |
970 |
763 |
$53K |
| J3490 |
Unclassified drugs |
27 |
24 |
$11K |
| 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 |
36 |
25 |
$10K |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
35 |
29 |
$8K |
| B9002 |
Enteral nutrition infusion pump, any type |
49 |
37 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
125 |
117 |
$2K |
| 90686 |
|
46 |
46 |
$2K |
| 90715 |
|
14 |
14 |
$777.02 |
| A4657 |
Syringe, with or without needle, each |
123 |
36 |
$424.03 |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
62 |
40 |
$332.88 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
92 |
51 |
$313.08 |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
22 |
15 |
$126.01 |
| 0250 |
|
50 |
38 |
$76.69 |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
365 |
351 |
$0.00 |
| 0760 |
|
92 |
87 |
$0.00 |
| 0515 |
|
266 |
263 |
$0.00 |