| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
1,098 |
1,016 |
$752K |
| B9998 |
Enteral supp not otherwise c |
2,148 |
1,174 |
$579K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,141 |
1,034 |
$290K |
| S9434 |
Mod solid food suppl |
375 |
257 |
$197K |
| B4035 |
Enteral feed supp pump per d |
798 |
688 |
$169K |
| B4150 |
Ef complet w/intact nutrient |
770 |
661 |
$93K |
| T4526 |
Adult size pull-on med |
738 |
691 |
$63K |
| T4527 |
Adult size pull-on lg |
718 |
645 |
$63K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,093 |
749 |
$46K |
| A4927 |
Non-sterile gloves |
2,157 |
1,745 |
$40K |
| T4528 |
Adult size pull-on xl |
378 |
348 |
$40K |
| T4541 |
Large disposable underpad |
1,668 |
1,543 |
$37K |
| T4535 |
Disposable liner/shield/pad |
1,110 |
967 |
$34K |
| T5999 |
Supply, nos |
135 |
110 |
$28K |
| B4100 |
Food thickener oral |
180 |
169 |
$25K |
| E1028 |
W/c manual swingaway |
1,801 |
1,007 |
$20K |
| T4522 |
Adult size brief/diaper med |
175 |
155 |
$18K |
| T4534 |
Youth size pull-on |
142 |
136 |
$17K |
| E2510 |
Sgd w multi methods msg/accs |
16 |
12 |
$17K |
| B9002 |
Enter nutr inf pump any type |
147 |
142 |
$15K |
| T2029 |
Special med equip, noswaiver |
13 |
12 |
$10K |
| T4530 |
Ped size brief/diaper lg |
47 |
41 |
$4K |
| E1399 |
Durable medical equipment mi |
22 |
12 |
$4K |
| K0001 |
Standard wheelchair |
124 |
99 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
215 |
141 |
$3K |
| A4335 |
Incontinence supply |
236 |
186 |
$3K |
| K0003 |
Lightweight wheelchair |
81 |
62 |
$2K |
| T4525 |
Adult size pull-on sm |
13 |
13 |
$1K |
| E0955 |
Cushioned headrest |
173 |
82 |
$683.29 |
| A4357 |
Bedside drainage bag |
21 |
12 |
$360.12 |
| A5120 |
Skin barrier, wipe or swab |
36 |
27 |
$165.41 |
| A7013 |
Disposable compressor filter |
30 |
24 |
$32.44 |