| 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 |
2,464 |
1,933 |
$590K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,186 |
1,921 |
$192K |
| 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 |
436 |
337 |
$93K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
763 |
593 |
$90K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
457 |
414 |
$49K |
| 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 |
282 |
216 |
$47K |
| 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 |
294 |
228 |
$47K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
868 |
768 |
$43K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
463 |
425 |
$34K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,008 |
837 |
$15K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
74 |
61 |
$15K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
237 |
214 |
$11K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
139 |
130 |
$9K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
206 |
177 |
$9K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
464 |
404 |
$7K |
| 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 |
13 |
12 |
$6K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
42 |
37 |
$1K |
| A4371 |
Ostomy skin barrier, powder, per oz |
409 |
357 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
43 |
38 |
$293.14 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
28 |
26 |
$225.30 |
| A4452 |
Tape, waterproof, per 18 square inches |
16 |
12 |
$71.01 |