| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
6,604 |
5,170 |
$357K |
| E0466 |
Home vent non-invasive inter |
1,442 |
1,214 |
$320K |
| B4035 |
Enteral feed supp pump per d |
2,179 |
1,447 |
$150K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,937 |
1,747 |
$138K |
| A4223 |
Infusion supplies w/o pump |
2,529 |
863 |
$112K |
| E0465 |
Home vent invasive interface |
475 |
361 |
$95K |
| B4034 |
Enter feed supkit syr by day |
1,641 |
1,040 |
$67K |
| B9002 |
Enter nutr inf pump any type |
1,680 |
1,428 |
$66K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
326 |
294 |
$60K |
| E0601 |
Cont airway pressure device |
1,303 |
1,200 |
$60K |
| E0445 |
Oximeter non-invasive |
399 |
376 |
$30K |
| E0431 |
Portable gaseous 02 |
1,603 |
1,292 |
$26K |
| E1392 |
Portable oxygen concentrator |
3,312 |
2,702 |
$22K |
| A4624 |
Tracheal suction tube |
391 |
271 |
$20K |
| B4150 |
Ef complet w/intact nutrient |
146 |
105 |
$14K |
| E0600 |
Suction pump portab hom modl |
1,069 |
809 |
$13K |
| E0562 |
Humidifier heated used w pap |
1,672 |
1,573 |
$9K |
| A7000 |
Disposable canister for pump |
782 |
535 |
$6K |
| E0570 |
Nebulizer with compression |
587 |
439 |
$5K |
| A4629 |
Tracheostomy care kit |
425 |
284 |
$5K |
| A7002 |
Tubing used w suction pump |
1,050 |
756 |
$3K |
| B9998 |
Enteral supp not otherwise c |
37 |
36 |
$3K |
| E0776 |
Iv pole |
1,130 |
808 |
$3K |
| 99601 |
|
28 |
13 |
$2K |
| E0565 |
Compressor air power source |
130 |
112 |
$2K |
| A7526 |
Tracheostomy tube collar |
449 |
330 |
$2K |
| A4221 |
Supp non-insulin inf cath/wk |
223 |
70 |
$1K |
| B4088 |
Gastro/jejuno tube, low-pro |
27 |
27 |
$667.72 |
| A6402 |
Sterile gauze <= 16 sq in |
542 |
405 |
$547.36 |
| A7520 |
Trach/laryn tube non-cuffed |
29 |
25 |
$411.65 |
| K0001 |
Standard wheelchair |
164 |
146 |
$230.29 |
| E0630 |
Patient lift hydraulic |
15 |
12 |
$166.91 |
| A4216 |
Sterile water/saline, 10 ml |
15 |
12 |
$143.57 |
| A4623 |
Tracheostomy inner cannula |
19 |
12 |
$100.22 |
| K0738 |
Portable gas oxygen system |
42 |
39 |
$0.00 |