| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home vent invasive interface |
2,203 |
2,138 |
$1.56M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,570 |
1,497 |
$1.28M |
| E0466 |
Home vent non-invasive inter |
1,672 |
1,626 |
$1.26M |
| B4035 |
Enteral feed supp pump per d |
3,808 |
3,714 |
$1.03M |
| B9998 |
Enteral supp not otherwise c |
6,968 |
4,749 |
$702K |
| E1390 |
Oxygen concentrator |
5,125 |
5,026 |
$567K |
| B4149 |
Ef blenderized foods |
1,569 |
1,059 |
$447K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,693 |
1,540 |
$423K |
| A4606 |
Oxygen probe used w oximeter |
3,541 |
3,373 |
$357K |
| E0482 |
Cough stimulating device |
1,527 |
1,436 |
$338K |
| B4155 |
Ef incomplete/modular |
1,257 |
1,163 |
$241K |
| A4554 |
Disposable underpads |
6,634 |
6,355 |
$213K |
| A4629 |
Tracheostomy care kit |
2,058 |
1,814 |
$157K |
| A4624 |
Tracheal suction tube |
1,405 |
1,326 |
$156K |
| A7000 |
Disposable canister for pump |
3,813 |
3,664 |
$138K |
| T4534 |
Youth size pull-on |
1,080 |
1,045 |
$122K |
| A4605 |
Trach suction cath close sys |
895 |
826 |
$108K |
| T4522 |
Adult size brief/diaper med |
1,097 |
1,022 |
$107K |
| A4322 |
Irrigation syringe |
4,177 |
4,004 |
$104K |
| T4530 |
Ped size brief/diaper lg |
1,106 |
1,053 |
$100K |
| E0445 |
Oximeter non-invasive |
851 |
737 |
$96K |
| E0431 |
Portable gaseous 02 |
4,787 |
4,675 |
$93K |
| A7520 |
Trach/laryn tube non-cuffed |
1,438 |
1,288 |
$71K |
| A9900 |
Supply/accessory/service |
4,265 |
2,799 |
$67K |
| A7002 |
Tubing used w suction pump |
3,915 |
3,767 |
$65K |
| A7526 |
Tracheostomy tube collar |
2,382 |
2,034 |
$60K |
| T4523 |
Adult size brief/diaper lg |
538 |
522 |
$53K |
| B4150 |
Ef complet w/intact nutrient |
214 |
212 |
$48K |
| E0601 |
Cont airway pressure device |
725 |
671 |
$46K |
| A4216 |
Sterile water/saline, 10 ml |
1,945 |
1,706 |
$44K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
337 |
305 |
$43K |
| A6402 |
Sterile gauze <= 16 sq in |
5,078 |
4,020 |
$40K |
| A4335 |
Incontinence supply |
7,871 |
7,470 |
$39K |
| T4521 |
Adult size brief/diaper sm |
370 |
351 |
$38K |
| A4483 |
Moisture exchanger |
777 |
682 |
$38K |
| E0562 |
Humidifier heated used w pap |
1,929 |
1,786 |
$29K |
| T1999 |
Noc retail items andsupplies |
6,704 |
3,745 |
$26K |
| T4527 |
Adult size pull-on lg |
159 |
156 |
$23K |
| A7521 |
Trach/laryn tube cuffed |
385 |
339 |
$22K |
| A6457 |
Tubular dressing |
858 |
839 |
$22K |
| A4628 |
Oropharyngeal suction cath |
4,343 |
3,920 |
$20K |
| A7003 |
Nebulizer administration set |
5,028 |
4,914 |
$17K |
| E0470 |
Rad w/o backup non-inv intfc |
93 |
92 |
$16K |
| A7030 |
Cpap full face mask |
143 |
142 |
$15K |
| B4104 |
Additive for enteral formula |
168 |
158 |
$12K |
| B9002 |
Enter nutr inf pump any type |
124 |
117 |
$10K |
| T4535 |
Disposable liner/shield/pad |
317 |
301 |
$9K |
| A4402 |
Lubricant per ounce |
1,819 |
1,628 |
$8K |
| B4034 |
Enter feed supkit syr by day |
64 |
61 |
$8K |
| A4353 |
Intermittent urinary cath |
12 |
12 |
$8K |
| A6216 |
Non-sterile gauze<=16 sq in |
840 |
810 |
$7K |
| A4927 |
Non-sterile gloves |
905 |
875 |
$6K |
| A6250 |
Skin seal protect moisturizr |
1,092 |
878 |
$6K |
| T4525 |
Adult size pull-on sm |
50 |
50 |
$6K |
| E0565 |
Compressor air power source |
191 |
183 |
$5K |
| A7015 |
Aerosol mask used w nebulize |
3,531 |
3,488 |
$4K |
| A7525 |
Tracheostomy mask |
1,277 |
1,213 |
$4K |
| A4450 |
Non-waterproof tape |
2,413 |
2,382 |
$4K |
| A7013 |
Disposable compressor filter |
3,609 |
3,518 |
$3K |
| A7037 |
Pos airway pressure tubing |
138 |
137 |
$3K |
| E0776 |
Iv pole |
152 |
145 |
$2K |
| A4657 |
Syringe w/wo needle |
1,313 |
997 |
$2K |
| A7038 |
Pos airway pressure filter |
242 |
239 |
$1K |
| A7035 |
Pos airway press headgear |
51 |
49 |
$939.11 |
| E0570 |
Nebulizer with compression |
13 |
12 |
$920.39 |
| A4452 |
Waterproof tape |
121 |
120 |
$756.88 |
| B4088 |
Gastro/jejuno tube, low-pro |
70 |
65 |
$596.68 |
| A4627 |
Spacer bag/reservoir |
13 |
13 |
$345.22 |
| A7007 |
Lg vol nebulizer disposable |
14 |
12 |
$52.11 |
| A4618 |
Breathing circuits |
12 |
12 |
$3.62 |
| A4616 |
Tubing (oxygen) per foot |
16 |
12 |
$2.48 |