| Code | Description | Total Paid |
|---|
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
$7.46M |
| J3380 |
Injection, vedolizumab, intravenous, 1 mg |
$4.27M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
$1.78M |
| 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 |
$1.33M |
| 99601 |
|
$1.24M |
| 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 |
$1.20M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
$1.12M |
| Q5103 |
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
$1.10M |
| S5170 |
Home delivered meals, including preparation; per meal |
$1.04M |
| 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 |
$711K |