| Code | Description | Total Paid |
|---|
| J0178 |
Injection, aflibercept, 1 mg |
$7.72M |
| 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 |
$5.62M |
| 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 |
$1.26M |
| J9035 |
Injection, bevacizumab, 10 mg |
$1.12M |
| J9271 |
Injection, pembrolizumab, 1 mg |
$918K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
$870K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
$752K |
| J9395 |
Injection, fulvestrant, 25 mg |
$713K |
| A4554 |
Disposable underpads, all sizes |
$682K |
| J9355 |
Injection, trastuzumab, excludes biosimilar, 10 mg |
$631K |