| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,516 |
2,292 |
$289K |
| E1390 |
Oxygen concentrator |
6,768 |
4,623 |
$240K |
| B4035 |
Enteral feed supp pump per d |
923 |
735 |
$194K |
| B4152 |
Ef calorie dense>/=1.5kcal |
940 |
848 |
$145K |
| E0431 |
Portable gaseous 02 |
4,127 |
2,786 |
$31K |
| B4161 |
Ef ped hydrolyzed/amino acid |
42 |
38 |
$17K |
| B9998 |
Enteral supp not otherwise c |
666 |
325 |
$17K |
| A7038 |
Pos airway pressure filter |
2,117 |
1,597 |
$9K |
| A7031 |
Replacement facemask interfa |
240 |
166 |
$7K |
| B9002 |
Enter nutr inf pump any type |
70 |
68 |
$6K |
| E0601 |
Cont airway pressure device |
357 |
226 |
$5K |
| A7034 |
Nasal application device |
161 |
116 |
$5K |
| E0562 |
Humidifier heated used w pap |
523 |
381 |
$5K |
| A7030 |
Cpap full face mask |
100 |
62 |
$3K |
| A7035 |
Pos airway press headgear |
362 |
255 |
$3K |
| A7037 |
Pos airway pressure tubing |
376 |
252 |
$3K |
| E0570 |
Nebulizer with compression |
366 |
243 |
$2K |
| A7046 |
Repl water chamber, pap dev |
224 |
157 |
$861.12 |
| E0776 |
Iv pole |
28 |
27 |
$166.69 |