| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4154 |
Ef spec metabolic noninherit |
29,460 |
14,132 |
$3.25M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
21,954 |
11,363 |
$2.51M |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,656 |
2,524 |
$1.78M |
| B4152 |
Ef calorie dense>/=1.5kcal |
14,972 |
8,794 |
$1.22M |
| B4150 |
Ef complet w/intact nutrient |
19,676 |
10,416 |
$1.14M |
| B4035 |
Enteral feed supp pump per d |
11,566 |
8,244 |
$1.04M |
| B9998 |
Enteral supp not otherwise c |
12,281 |
6,529 |
$645K |
| E0601 |
Cont airway pressure device |
8,064 |
7,166 |
$607K |
| E0570 |
Nebulizer with compression |
9,658 |
9,215 |
$433K |
| B4034 |
Enter feed supkit syr by day |
6,418 |
4,943 |
$257K |
| E1390 |
Oxygen concentrator |
3,624 |
3,245 |
$246K |
| E0470 |
Rad w/o backup non-inv intfc |
1,309 |
1,176 |
$244K |
| B4153 |
Ef hydrolyzed/amino acids |
6,891 |
3,068 |
$222K |
| A7031 |
Replacement facemask interfa |
5,000 |
4,769 |
$208K |
| A7030 |
Cpap full face mask |
2,065 |
1,985 |
$199K |
| B4102 |
Ef adult fluids and electro |
5,347 |
2,836 |
$187K |
| B9002 |
Enter nutr inf pump any type |
3,710 |
3,129 |
$185K |
| B4155 |
Ef incomplete/modular |
3,884 |
2,832 |
$159K |
| E0562 |
Humidifier heated used w pap |
8,654 |
8,065 |
$156K |
| T4534 |
Youth size pull-on |
1,111 |
909 |
$150K |
| A7037 |
Pos airway pressure tubing |
4,407 |
4,266 |
$108K |
| A7034 |
Nasal application device |
1,335 |
1,273 |
$92K |
| A7032 |
Replacement nasal cushion |
1,521 |
1,470 |
$86K |
| A7038 |
Pos airway pressure filter |
10,333 |
9,767 |
$75K |
| A7035 |
Pos airway press headgear |
3,228 |
3,106 |
$72K |
| T4522 |
Adult size brief/diaper med |
559 |
463 |
$54K |
| A7033 |
Replacement nasal pillows |
1,070 |
1,036 |
$41K |
| A4322 |
Irrigation syringe |
1,590 |
1,150 |
$41K |
| K0001 |
Standard wheelchair |
1,971 |
1,833 |
$41K |
| E0143 |
Walker folding wheeled w/o s |
603 |
577 |
$31K |
| E0260 |
Hosp bed semi-electr w/ matt |
347 |
276 |
$22K |
| A7046 |
Repl water chamber, pap dev |
1,706 |
1,597 |
$16K |
| E0431 |
Portable gaseous 02 |
2,535 |
2,244 |
$16K |
| E0776 |
Iv pole |
3,676 |
3,214 |
$13K |
| E0261 |
Hosp bed semi-electr w/o mat |
237 |
217 |
$12K |
| A7526 |
Tracheostomy tube collar |
358 |
300 |
$6K |
| A7000 |
Disposable canister for pump |
983 |
848 |
$5K |
| A5500 |
Diab shoe for density insert |
111 |
79 |
$5K |
| A7036 |
Pos airway press chinstrap |
361 |
341 |
$3K |
| E0443 |
Portable 02 contents, gas |
217 |
213 |
$3K |
| K0195 |
Elevating whlchair leg rests |
78 |
60 |
$2K |
| A5512 |
Multi den insert direct form |
126 |
91 |
$2K |
| A7002 |
Tubing used w suction pump |
929 |
794 |
$2K |
| Q0513 |
Disp fee inhal drugs/30 days |
218 |
213 |
$2K |
| B4036 |
Enteral feed sup kit grav by |
14 |
13 |
$2K |
| E0600 |
Suction pump portab hom modl |
41 |
37 |
$1K |
| A4629 |
Tracheostomy care kit |
27 |
24 |
$1K |
| A4624 |
Tracheal suction tube |
15 |
14 |
$1K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
24 |
24 |
$951.52 |
| A4628 |
Oropharyngeal suction cath |
210 |
183 |
$740.35 |
| A4222 |
Infusion supplies with pump |
32 |
12 |
$284.61 |
| E0163 |
Commode chair with fixed arm |
13 |
13 |
$202.43 |
| E0156 |
Walker seat attachment |
24 |
24 |
$181.61 |
| A5120 |
Skin barrier, wipe or swab |
28 |
26 |
$135.20 |
| E0971 |
Wheelchair anti-tipping devi |
27 |
12 |
$95.61 |
| A7039 |
Filter, non disposable w pap |
12 |
12 |
$95.22 |
| A4357 |
Bedside drainage bag |
18 |
14 |
$82.07 |
| A6402 |
Sterile gauze <= 16 sq in |
13 |
12 |
$66.74 |
| 90656 |
|
312 |
308 |
$0.00 |
| 0012A |
|
227 |
227 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
266 |
265 |
$0.00 |
| 0064A |
|
363 |
363 |
$0.00 |
| G0008 |
Admin influenza virus vac |
2,574 |
2,548 |
$0.00 |
| 0134A |
|
413 |
413 |
$0.00 |
| 0011A |
|
576 |
576 |
$0.00 |
| 90686 |
|
2,127 |
2,107 |
$0.00 |
| 90688 |
|
124 |
122 |
$0.00 |
| 90480 |
|
752 |
734 |
$0.00 |
| 90732 |
|
91 |
91 |
$0.00 |
| 90677 |
|
80 |
80 |
$0.00 |
| 90670 |
|
45 |
44 |
$0.00 |
| 91320 |
|
752 |
734 |
$0.00 |