| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home vent invasive interface |
2,058 |
2,040 |
$1.65M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,608 |
1,580 |
$1.23M |
| E1390 |
Oxygen concentrator |
9,659 |
9,572 |
$1.04M |
| B4035 |
Enteral feed supp pump per d |
3,813 |
3,719 |
$1.01M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,863 |
2,821 |
$665K |
| B9998 |
Enteral supp not otherwise c |
4,987 |
4,156 |
$424K |
| B4149 |
Ef blenderized foods |
969 |
963 |
$411K |
| A4606 |
Oxygen probe used w oximeter |
3,940 |
3,886 |
$383K |
| E0482 |
Cough stimulating device |
1,395 |
1,370 |
$349K |
| E0466 |
Home vent non-invasive inter |
471 |
454 |
$315K |
| E0445 |
Oximeter non-invasive |
1,831 |
1,812 |
$278K |
| A4624 |
Tracheal suction tube |
2,200 |
2,149 |
$277K |
| B4150 |
Ef complet w/intact nutrient |
818 |
809 |
$234K |
| A4629 |
Tracheostomy care kit |
2,168 |
2,125 |
$203K |
| E0431 |
Portable gaseous 02 |
9,186 |
9,118 |
$179K |
| E0570 |
Nebulizer with compression |
1,691 |
1,679 |
$163K |
| A7000 |
Disposable canister for pump |
5,075 |
5,035 |
$127K |
| A4554 |
Disposable underpads |
4,307 |
4,238 |
$127K |
| B9002 |
Enter nutr inf pump any type |
982 |
972 |
$126K |
| T4534 |
Youth size pull-on |
995 |
977 |
$111K |
| A7520 |
Trach/laryn tube non-cuffed |
1,828 |
1,769 |
$105K |
| T4530 |
Ped size brief/diaper lg |
1,054 |
1,037 |
$97K |
| B4034 |
Enter feed supkit syr by day |
790 |
767 |
$81K |
| A7526 |
Tracheostomy tube collar |
2,609 |
2,478 |
$67K |
| A6402 |
Sterile gauze <= 16 sq in |
4,629 |
4,323 |
$64K |
| A7002 |
Tubing used w suction pump |
5,216 |
5,156 |
$61K |
| A7521 |
Trach/laryn tube cuffed |
388 |
382 |
$54K |
| T1999 |
Noc retail items andsupplies |
4,626 |
3,391 |
$54K |
| K0001 |
Standard wheelchair |
2,216 |
2,186 |
$52K |
| B4155 |
Ef incomplete/modular |
165 |
163 |
$44K |
| E0424 |
Stationary compressed gas 02 |
357 |
353 |
$39K |
| A4216 |
Sterile water/saline, 10 ml |
2,259 |
2,178 |
$34K |
| A4217 |
Sterile water/saline, 500 ml |
1,339 |
1,285 |
$29K |
| A4322 |
Irrigation syringe |
3,414 |
3,389 |
$26K |
| A4627 |
Spacer bag/reservoir |
1,041 |
1,040 |
$26K |
| A4335 |
Incontinence supply |
5,152 |
5,043 |
$25K |
| A4605 |
Trach suction cath close sys |
171 |
166 |
$23K |
| K0195 |
Elevating whlchair leg rests |
2,239 |
2,216 |
$19K |
| A4628 |
Oropharyngeal suction cath |
3,492 |
3,448 |
$19K |
| E0483 |
Hi freq chest wall oscil sys |
25 |
24 |
$18K |
| T4523 |
Adult size brief/diaper lg |
159 |
146 |
$15K |
| T4522 |
Adult size brief/diaper med |
138 |
137 |
$14K |
| T4526 |
Adult size pull-on med |
116 |
116 |
$13K |
| A7003 |
Nebulizer administration set |
4,806 |
4,756 |
$12K |
| A4452 |
Waterproof tape |
644 |
596 |
$12K |
| E0601 |
Cont airway pressure device |
247 |
243 |
$10K |
| A4481 |
Tracheostoma filter |
688 |
595 |
$10K |
| A6216 |
Non-sterile gauze<=16 sq in |
838 |
824 |
$6K |
| E0776 |
Iv pole |
663 |
658 |
$6K |
| A6250 |
Skin seal protect moisturizr |
708 |
691 |
$5K |
| A7015 |
Aerosol mask used w nebulize |
2,896 |
2,863 |
$3K |
| A7030 |
Cpap full face mask |
40 |
40 |
$3K |
| E0562 |
Humidifier heated used w pap |
174 |
171 |
$3K |
| A7007 |
Lg vol nebulizer disposable |
556 |
518 |
$3K |
| E0990 |
Wheelchair elevating leg res |
284 |
280 |
$3K |
| T4521 |
Adult size brief/diaper sm |
28 |
24 |
$3K |
| A7012 |
Nebulizer water collec devic |
483 |
474 |
$2K |
| A7037 |
Pos airway pressure tubing |
134 |
134 |
$2K |
| A7525 |
Tracheostomy mask |
735 |
720 |
$2K |
| A4332 |
Lube sterile packet |
402 |
390 |
$1K |
| A7038 |
Pos airway pressure filter |
257 |
256 |
$952.35 |
| A7035 |
Pos airway press headgear |
13 |
13 |
$143.35 |
| A7039 |
Filter, non disposable w pap |
12 |
12 |
$51.43 |