| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
2,252 |
2,176 |
$596K |
| E1390 |
Oxygen concentrator |
4,144 |
4,007 |
$587K |
| B4161 |
Ef ped hydrolyzed/amino acid |
827 |
654 |
$581K |
| E0465 |
Home vent invasive interface |
908 |
845 |
$518K |
| T4534 |
Youth size pull-on |
3,609 |
3,549 |
$464K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,078 |
3,007 |
$397K |
| A4624 |
Tracheal suction tube |
2,350 |
2,229 |
$308K |
| A4554 |
Disposable underpads |
7,763 |
7,608 |
$242K |
| T4530 |
Ped size brief/diaper lg |
2,127 |
2,084 |
$195K |
| E0601 |
Cont airway pressure device |
2,680 |
2,628 |
$179K |
| B9002 |
Enter nutr inf pump any type |
2,473 |
2,413 |
$177K |
| E0445 |
Oximeter non-invasive |
2,927 |
2,870 |
$172K |
| T4522 |
Adult size brief/diaper med |
1,499 |
1,457 |
$166K |
| E0466 |
Home vent non-invasive inter |
230 |
220 |
$160K |
| B4149 |
Ef blenderized foods |
558 |
510 |
$155K |
| B4150 |
Ef complet w/intact nutrient |
924 |
893 |
$129K |
| T4526 |
Adult size pull-on med |
1,092 |
1,069 |
$127K |
| E0471 |
Rad w/backup non inv intrfc |
362 |
355 |
$126K |
| T4521 |
Adult size brief/diaper sm |
1,187 |
1,161 |
$125K |
| A4629 |
Tracheostomy care kit |
1,034 |
987 |
$107K |
| B9998 |
Enteral supp not otherwise c |
2,815 |
2,273 |
$100K |
| T4525 |
Adult size pull-on sm |
900 |
881 |
$97K |
| E0570 |
Nebulizer with compression |
996 |
974 |
$83K |
| E0431 |
Portable gaseous 02 |
3,687 |
3,583 |
$82K |
| A4927 |
Non-sterile gloves |
6,805 |
6,653 |
$81K |
| T4527 |
Adult size pull-on lg |
418 |
410 |
$58K |
| T4532 |
Ped size pull-on lg |
521 |
509 |
$56K |
| A9900 |
Supply/accessory/service |
569 |
538 |
$42K |
| E0600 |
Suction pump portab hom modl |
954 |
887 |
$22K |
| E0562 |
Humidifier heated used w pap |
3,856 |
3,777 |
$19K |
| A7003 |
Nebulizer administration set |
1,978 |
1,922 |
$16K |
| B4088 |
Gastro/jejuno tube, low-pro |
191 |
175 |
$15K |
| A7508 |
Housing & integrated adhesiv |
273 |
263 |
$13K |
| A7526 |
Tracheostomy tube collar |
1,132 |
1,084 |
$11K |
| T4523 |
Adult size brief/diaper lg |
100 |
99 |
$10K |
| A7005 |
Nondisposable nebulizer set |
864 |
851 |
$9K |
| K0001 |
Standard wheelchair |
244 |
221 |
$6K |
| A4213 |
20+ cc syringe only |
203 |
190 |
$4K |
| A7002 |
Tubing used w suction pump |
1,964 |
1,891 |
$3K |
| E1392 |
Portable oxygen concentrator |
238 |
223 |
$3K |
| E0565 |
Compressor air power source |
102 |
101 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
2,210 |
2,163 |
$2K |
| A4209 |
5+ cc sterile syringe&needle |
379 |
351 |
$901.84 |
| A4216 |
Sterile water/saline, 10 ml |
141 |
122 |
$588.68 |
| A7525 |
Tracheostomy mask |
182 |
170 |
$207.50 |
| A7014 |
Compressor nondispos filter |
84 |
83 |
$182.39 |
| A7000 |
Disposable canister for pump |
12 |
12 |
$64.90 |