| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
26,013 |
19,346 |
$3.37M |
| B4149 |
Ef blenderized foods |
9,077 |
5,609 |
$2.33M |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,975 |
3,145 |
$1.30M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
8,731 |
6,007 |
$1.07M |
| B4088 |
Gastro/jejuno tube, low-pro |
13,714 |
8,893 |
$834K |
| B4150 |
Ef complet w/intact nutrient |
5,445 |
3,694 |
$716K |
| B4152 |
Ef calorie dense>/=1.5kcal |
7,005 |
3,587 |
$588K |
| B4153 |
Ef hydrolyzed/amino acids |
1,253 |
908 |
$478K |
| T1999 |
Noc retail items andsupplies |
24,994 |
3,576 |
$322K |
| B4154 |
Ef spec metabolic noninherit |
1,480 |
918 |
$302K |
| B4036 |
Enteral feed sup kit grav by |
4,728 |
2,628 |
$292K |
| S9500 |
Hit antibiotic q24h diem |
772 |
293 |
$227K |
| 99601 |
|
1,574 |
605 |
$169K |
| B4034 |
Enter feed supkit syr by day |
17,442 |
2,240 |
$134K |
| B4158 |
Ef ped complete intact nut |
1,046 |
722 |
$72K |
| B4155 |
Ef incomplete/modular |
2,400 |
1,843 |
$65K |
| A6402 |
Sterile gauze <= 16 sq in |
6,865 |
5,671 |
$63K |
| A4305 |
Drug delivery system >=50 ml |
823 |
281 |
$57K |
| B9002 |
Enter nutr inf pump any type |
1,209 |
705 |
$39K |
| E0776 |
Iv pole |
535 |
464 |
$31K |
| A4213 |
20+ cc syringe only |
4,585 |
3,053 |
$20K |
| S1015 |
Iv tubing extension set |
2,020 |
815 |
$11K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
3,809 |
1,502 |
$10K |
| A4452 |
Waterproof tape |
4,630 |
4,060 |
$10K |
| A4322 |
Irrigation syringe |
1,906 |
1,518 |
$10K |
| A4209 |
5+ cc sterile syringe&needle |
2,227 |
877 |
$4K |
| A4450 |
Non-waterproof tape |
1,714 |
1,472 |
$4K |
| A6258 |
Transparent film >16<=48 in |
376 |
137 |
$2K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
110 |
87 |
$2K |
| S9342 |
Hit enteral pump diem |
1,066 |
281 |
$1K |
| A6257 |
Transparent film <= 16 sq in |
636 |
342 |
$1K |
| A4927 |
Non-sterile gloves |
20 |
13 |
$144.77 |
| A4402 |
Lubricant per ounce |
78 |
70 |
$4.14 |
| A9270 |
Non-covered item or service |
89 |
44 |
$0.00 |