| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
520 |
484 |
$74K |
| B4150 |
Ef complet w/intact nutrient |
529 |
497 |
$54K |
| T4541 |
Large disposable underpad |
623 |
591 |
$22K |
| A9901 |
Delivery/set up/dispensing |
3,958 |
3,780 |
$17K |
| B4161 |
Ef ped hydrolyzed/amino acid |
42 |
40 |
$4K |
| T4534 |
Youth size pull-on |
62 |
61 |
$2K |
| A6250 |
Skin seal protect moisturizr |
343 |
275 |
$2K |
| E0570 |
Nebulizer with compression |
96 |
93 |
$1K |
| T4523 |
Adult size brief/diaper lg |
28 |
27 |
$1K |
| A4670 |
Automatic bp monitor, dial |
24 |
24 |
$665.00 |
| A7015 |
Aerosol mask used w nebulize |
12 |
12 |
$42.50 |