| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
11,133 |
9,508 |
$2.51M |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,525 |
3,422 |
$2.31M |
| B9998 |
Enteral supp not otherwise c |
14,674 |
10,654 |
$1.53M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,622 |
3,510 |
$998K |
| E1390 |
Oxygen concentrator |
6,900 |
6,736 |
$679K |
| A4606 |
Oxygen probe used w oximeter |
9,394 |
4,445 |
$571K |
| E0445 |
Oximeter non-invasive |
1,873 |
1,826 |
$541K |
| B4158 |
Ef ped complete intact nut |
1,705 |
1,672 |
$429K |
| E0465 |
Home vent invasive interface |
678 |
658 |
$417K |
| B4149 |
Ef blenderized foods |
994 |
969 |
$389K |
| B9002 |
Enter nutr inf pump any type |
1,975 |
1,948 |
$383K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,396 |
2,158 |
$307K |
| B4153 |
Ef hydrolyzed/amino acids |
148 |
136 |
$241K |
| E0466 |
Home vent non-invasive inter |
348 |
340 |
$236K |
| A6212 |
Foam drg <=16 sq in w/border |
1,343 |
1,191 |
$226K |
| A4554 |
Disposable underpads |
4,935 |
4,626 |
$178K |
| A4322 |
Irrigation syringe |
13,006 |
9,229 |
$148K |
| B4154 |
Ef spec metabolic noninherit |
316 |
302 |
$147K |
| K0001 |
Standard wheelchair |
3,960 |
3,742 |
$126K |
| T4534 |
Youth size pull-on |
1,183 |
1,085 |
$122K |
| B4155 |
Ef incomplete/modular |
963 |
934 |
$118K |
| E0431 |
Portable gaseous 02 |
6,795 |
6,625 |
$116K |
| T4530 |
Ped size brief/diaper lg |
1,367 |
1,215 |
$110K |
| T1999 |
Noc retail items andsupplies |
6,403 |
4,323 |
$96K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
4,759 |
4,603 |
$92K |
| A7000 |
Disposable canister for pump |
3,946 |
3,145 |
$87K |
| A4624 |
Tracheal suction tube |
729 |
662 |
$77K |
| A4605 |
Trach suction cath close sys |
634 |
513 |
$71K |
| A6258 |
Transparent film >16<=48 in |
4,857 |
4,634 |
$65K |
| A4629 |
Tracheostomy care kit |
767 |
741 |
$59K |
| A6402 |
Sterile gauze <= 16 sq in |
8,926 |
8,421 |
$55K |
| A7002 |
Tubing used w suction pump |
4,755 |
3,217 |
$52K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
233 |
137 |
$44K |
| B4100 |
Food thickener oral |
179 |
173 |
$38K |
| T4522 |
Adult size brief/diaper med |
419 |
384 |
$37K |
| A7526 |
Tracheostomy tube collar |
1,516 |
906 |
$35K |
| K0195 |
Elevating whlchair leg rests |
3,205 |
3,009 |
$34K |
| A4335 |
Incontinence supply |
5,959 |
5,484 |
$27K |
| A9279 |
Monitoring feature/devicenoc |
156 |
139 |
$25K |
| E0143 |
Walker folding wheeled w/o s |
427 |
423 |
$25K |
| E0482 |
Cough stimulating device |
95 |
95 |
$23K |
| B4082 |
Enteral ng tubing w/o stylet |
844 |
787 |
$20K |
| A4351 |
Straight tip urine catheter |
160 |
147 |
$19K |
| A4927 |
Non-sterile gloves |
3,575 |
3,284 |
$18K |
| E0978 |
W/c acc,saf belt pelv strap |
697 |
674 |
$18K |
| A4670 |
Automatic bp monitor, dial |
397 |
379 |
$17K |
| A4628 |
Oropharyngeal suction cath |
3,391 |
3,030 |
$15K |
| E1226 |
Manual fully reclining back |
378 |
348 |
$12K |
| E0601 |
Cont airway pressure device |
211 |
201 |
$12K |
| B4150 |
Ef complet w/intact nutrient |
51 |
50 |
$12K |
| E0240 |
Bath/shower chair |
170 |
166 |
$12K |
| E0776 |
Iv pole |
189 |
185 |
$11K |
| A4217 |
Sterile water/saline, 500 ml |
449 |
366 |
$11K |
| A4216 |
Sterile water/saline, 10 ml |
1,255 |
602 |
$9K |
| E0247 |
Trans bench w/wo comm open |
130 |
123 |
$8K |
| A7520 |
Trach/laryn tube non-cuffed |
290 |
264 |
$7K |
| A4402 |
Lubricant per ounce |
1,678 |
1,589 |
$7K |
| A7003 |
Nebulizer administration set |
2,528 |
2,446 |
$5K |
| B4034 |
Enter feed supkit syr by day |
41 |
40 |
$5K |
| K0053 |
Elevate footrest articulate |
662 |
395 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
612 |
495 |
$4K |
| E0570 |
Nebulizer with compression |
54 |
51 |
$4K |
| T4527 |
Adult size pull-on lg |
26 |
26 |
$3K |
| A4450 |
Non-waterproof tape |
1,089 |
742 |
$3K |
| T4535 |
Disposable liner/shield/pad |
72 |
67 |
$2K |
| T4532 |
Ped size pull-on lg |
19 |
14 |
$2K |
| A4357 |
Bedside drainage bag |
191 |
178 |
$2K |
| T4526 |
Adult size pull-on med |
12 |
12 |
$1K |
| B4103 |
Ef ped fluid and electrolyte |
12 |
12 |
$1K |
| A7521 |
Trach/laryn tube cuffed |
13 |
13 |
$434.94 |
| A4452 |
Waterproof tape |
52 |
52 |
$281.21 |
| A7015 |
Aerosol mask used w nebulize |
266 |
250 |
$263.12 |
| A7525 |
Tracheostomy mask |
113 |
106 |
$209.47 |
| A4456 |
Adhesive remover, wipes |
17 |
12 |
$140.55 |
| A4371 |
Skin barrier powder per oz |
13 |
12 |
$62.70 |
| B4104 |
Additive for enteral formula |
126 |
119 |
$3.36 |