| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
1,827 |
703 |
$253K |
| B4161 |
Ef ped hydrolyzed/amino acid |
189 |
177 |
$232K |
| E1028 |
W/c manual swingaway |
1,075 |
788 |
$142K |
| K0005 |
Ultralightweight wheelchair |
75 |
72 |
$126K |
| B9998 |
Enteral supp not otherwise c |
702 |
581 |
$107K |
| E1399 |
Durable medical equipment mi |
103 |
31 |
$100K |
| B4035 |
Enteral feed supp pump per d |
419 |
399 |
$96K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
187 |
166 |
$66K |
| B4152 |
Ef calorie dense>/=1.5kcal |
434 |
414 |
$57K |
| T4523 |
Adult size brief/diaper lg |
428 |
414 |
$54K |
| E0973 |
W/ch access det adj armrest |
413 |
314 |
$40K |
| K0739 |
Repair/svc dme non-oxygen eq |
723 |
640 |
$32K |
| E0955 |
Cushioned headrest |
370 |
351 |
$31K |
| K0040 |
Adjustable angle footplate |
307 |
239 |
$30K |
| B4150 |
Ef complet w/intact nutrient |
185 |
159 |
$28K |
| A4425 |
Ost pch drain for barrier fl |
254 |
250 |
$24K |
| E2607 |
Skin pro/pos wc cus wd <22in |
110 |
102 |
$23K |
| A4385 |
Ost skn barrier sld ext wear |
217 |
205 |
$22K |
| T4522 |
Adult size brief/diaper med |
219 |
205 |
$18K |
| E0971 |
Wheelchair anti-tipping devi |
269 |
213 |
$15K |
| B9002 |
Enter nutr inf pump any type |
14 |
14 |
$13K |
| K0823 |
Pwc gp 2 std cap chair |
12 |
12 |
$13K |
| A4322 |
Irrigation syringe |
541 |
513 |
$13K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
268 |
244 |
$12K |
| A9901 |
Delivery/set up/dispensing |
1,388 |
1,334 |
$11K |
| A4927 |
Non-sterile gloves |
1,167 |
1,047 |
$11K |
| T4530 |
Ped size brief/diaper lg |
133 |
125 |
$10K |
| A4407 |
Ext wear ost skn barr <=4sq" |
41 |
39 |
$9K |
| A4456 |
Adhesive remover, wipes |
604 |
584 |
$8K |
| A4554 |
Disposable underpads |
279 |
268 |
$7K |
| E2213 |
Pneumatic prop tire insert |
152 |
119 |
$6K |
| A5057 |
1 pc ost pou w built-in conv |
26 |
26 |
$6K |
| E1161 |
Manual adult wc w tiltinspac |
12 |
12 |
$6K |
| E2211 |
Pneumatic propulsion tire |
136 |
109 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
137 |
130 |
$6K |
| E2620 |
Wc planar back cush wd <22in |
14 |
14 |
$5K |
| B4088 |
Gastro/jejuno tube, low-pro |
85 |
84 |
$5K |
| A5120 |
Skin barrier, wipe or swab |
528 |
514 |
$5K |
| A4367 |
Ostomy belt |
424 |
410 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
363 |
358 |
$3K |
| A4371 |
Skin barrier powder per oz |
585 |
564 |
$2K |
| A4452 |
Waterproof tape |
57 |
55 |
$1K |
| E0956 |
W/c lateral trunk/hip suppor |
17 |
13 |
$1K |
| E0951 |
Loop heel |
43 |
36 |
$1K |
| E0960 |
W/c shoulder harness/straps |
13 |
12 |
$1K |
| A4455 |
Adhesive remover per ounce |
326 |
311 |
$1K |
| B4034 |
Enter feed supkit syr by day |
38 |
26 |
$844.53 |
| A4362 |
Solid skin barrier |
13 |
12 |
$820.11 |
| E2219 |
Foam caster tire any size ea |
16 |
12 |
$686.32 |
| K0038 |
Leg strap each |
13 |
13 |
$585.61 |
| A4450 |
Non-waterproof tape |
148 |
146 |
$393.95 |
| A4394 |
Ostomy pouch liq deodorant |
12 |
12 |
$182.77 |