| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
3,547 |
3,436 |
$2.92M |
| B4035 |
Enteral feed supp pump per d |
8,887 |
8,675 |
$2.71M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
5,772 |
5,633 |
$1.53M |
| B9998 |
Enteral supp not otherwise c |
14,249 |
10,657 |
$1.42M |
| E0570 |
Nebulizer with compression |
13,810 |
13,609 |
$1.34M |
| E0465 |
Home vent invasive interface |
1,453 |
1,433 |
$1.32M |
| B4149 |
Ef blenderized foods |
2,715 |
2,582 |
$1.15M |
| E1390 |
Oxygen concentrator |
8,323 |
8,200 |
$1.03M |
| E0482 |
Cough stimulating device |
2,318 |
2,278 |
$653K |
| A4606 |
Oxygen probe used w oximeter |
4,303 |
3,716 |
$488K |
| B4155 |
Ef incomplete/modular |
1,424 |
1,329 |
$435K |
| E0601 |
Cont airway pressure device |
6,355 |
6,286 |
$412K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,615 |
1,551 |
$277K |
| T4530 |
Ped size brief/diaper lg |
2,666 |
2,530 |
$257K |
| A7030 |
Cpap full face mask |
2,389 |
2,362 |
$252K |
| A4627 |
Spacer bag/reservoir |
9,568 |
9,404 |
$246K |
| A7005 |
Nondisposable nebulizer set |
13,872 |
13,713 |
$237K |
| B4158 |
Ef ped complete intact nut |
838 |
808 |
$223K |
| B9002 |
Enter nutr inf pump any type |
708 |
691 |
$221K |
| T1999 |
Noc retail items andsupplies |
15,690 |
9,974 |
$208K |
| B4104 |
Additive for enteral formula |
2,238 |
2,098 |
$189K |
| E0445 |
Oximeter non-invasive |
523 |
507 |
$175K |
| A4554 |
Disposable underpads |
5,498 |
5,340 |
$168K |
| E0562 |
Humidifier heated used w pap |
1,856 |
1,811 |
$168K |
| E0431 |
Portable gaseous 02 |
7,482 |
7,407 |
$167K |
| E0470 |
Rad w/o backup non-inv intfc |
891 |
880 |
$160K |
| T4534 |
Youth size pull-on |
1,329 |
1,283 |
$139K |
| A4629 |
Tracheostomy care kit |
988 |
959 |
$134K |
| A7000 |
Disposable canister for pump |
4,194 |
4,110 |
$122K |
| A4605 |
Trach suction cath close sys |
605 |
581 |
$89K |
| A4322 |
Irrigation syringe |
8,734 |
8,454 |
$89K |
| A4483 |
Moisture exchanger |
1,144 |
1,013 |
$87K |
| A7002 |
Tubing used w suction pump |
4,272 |
4,141 |
$85K |
| S8101 |
Spacer with mask |
3,148 |
3,100 |
$82K |
| A7520 |
Trach/laryn tube non-cuffed |
1,638 |
1,588 |
$70K |
| A7526 |
Tracheostomy tube collar |
2,176 |
2,060 |
$68K |
| A7031 |
Replacement facemask interfa |
1,648 |
1,634 |
$67K |
| A7037 |
Pos airway pressure tubing |
3,451 |
3,411 |
$65K |
| A4335 |
Incontinence supply |
9,369 |
8,925 |
$57K |
| A4217 |
Sterile water/saline, 500 ml |
1,290 |
1,218 |
$53K |
| A7034 |
Nasal application device |
716 |
710 |
$47K |
| T4522 |
Adult size brief/diaper med |
474 |
460 |
$45K |
| A7035 |
Pos airway press headgear |
1,908 |
1,885 |
$38K |
| A4216 |
Sterile water/saline, 10 ml |
1,752 |
1,710 |
$33K |
| A6216 |
Non-sterile gauze<=16 sq in |
6,571 |
6,380 |
$31K |
| A4628 |
Oropharyngeal suction cath |
4,497 |
4,369 |
$29K |
| A4624 |
Tracheal suction tube |
215 |
209 |
$29K |
| K0001 |
Standard wheelchair |
738 |
727 |
$28K |
| A9900 |
Supply/accessory/service |
180 |
132 |
$26K |
| A4927 |
Non-sterile gloves |
3,025 |
2,922 |
$25K |
| A7015 |
Aerosol mask used w nebulize |
17,368 |
17,120 |
$21K |
| A7038 |
Pos airway pressure filter |
3,929 |
3,880 |
$21K |
| A7003 |
Nebulizer administration set |
5,258 |
5,130 |
$18K |
| T4533 |
Youth size brief/diaper |
170 |
167 |
$16K |
| E1399 |
Durable medical equipment mi |
99 |
88 |
$13K |
| A6257 |
Transparent film <= 16 sq in |
352 |
347 |
$12K |
| A4450 |
Non-waterproof tape |
6,404 |
6,283 |
$10K |
| A4353 |
Intermittent urinary cath |
16 |
12 |
$9K |
| A7013 |
Disposable compressor filter |
14,724 |
14,549 |
$9K |
| A6402 |
Sterile gauze <= 16 sq in |
829 |
782 |
$8K |
| K0195 |
Elevating whlchair leg rests |
605 |
593 |
$8K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
54 |
52 |
$8K |
| A4657 |
Syringe w/wo needle |
1,103 |
1,083 |
$6K |
| A7032 |
Replacement nasal cushion |
122 |
121 |
$5K |
| A6250 |
Skin seal protect moisturizr |
994 |
929 |
$5K |
| B4100 |
Food thickener oral |
95 |
88 |
$4K |
| B4082 |
Enteral ng tubing w/o stylet |
53 |
49 |
$4K |
| T4532 |
Ped size pull-on lg |
24 |
24 |
$3K |
| A4332 |
Lube sterile packet |
5,395 |
5,256 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
213 |
207 |
$2K |
| A7525 |
Tracheostomy mask |
494 |
397 |
$2K |
| A7046 |
Repl water chamber, pap dev |
115 |
93 |
$1K |
| A7007 |
Lg vol nebulizer disposable |
12 |
12 |
$62.33 |