| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
55,871 |
46,564 |
$31.81M |
| B4035 |
Enteral feed supp pump per d |
126,795 |
102,869 |
$25.11M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
114,426 |
99,346 |
$22.52M |
| B9998 |
Enteral supp not otherwise c |
137,518 |
111,420 |
$10.04M |
| T4534 |
Youth size pull-on |
70,945 |
64,735 |
$7.16M |
| B4153 |
Ef hydrolyzed/amino acids |
7,232 |
6,233 |
$6.38M |
| B4149 |
Ef blenderized foods |
18,853 |
15,677 |
$5.98M |
| A4554 |
Disposable underpads |
169,685 |
160,072 |
$5.03M |
| B4155 |
Ef incomplete/modular |
24,182 |
21,320 |
$4.87M |
| B4150 |
Ef complet w/intact nutrient |
22,527 |
19,619 |
$3.60M |
| B4152 |
Ef calorie dense>/=1.5kcal |
18,044 |
15,550 |
$3.38M |
| T4530 |
Ped size brief/diaper lg |
39,736 |
36,265 |
$3.12M |
| B4154 |
Ef spec metabolic noninherit |
7,529 |
6,096 |
$2.61M |
| T4532 |
Ped size pull-on lg |
19,775 |
17,978 |
$2.42M |
| E0465 |
Home vent invasive interface |
3,038 |
2,834 |
$2.37M |
| T4526 |
Adult size pull-on med |
23,589 |
22,269 |
$2.29M |
| B4034 |
Enter feed supkit syr by day |
25,690 |
20,960 |
$2.25M |
| T4522 |
Adult size brief/diaper med |
25,802 |
23,874 |
$2.25M |
| T4527 |
Adult size pull-on lg |
17,465 |
16,607 |
$1.92M |
| B9002 |
Enter nutr inf pump any type |
24,123 |
22,209 |
$1.79M |
| B4158 |
Ef ped complete intact nut |
10,513 |
8,913 |
$1.77M |
| A4606 |
Oxygen probe used w oximeter |
13,174 |
10,895 |
$1.45M |
| T4523 |
Adult size brief/diaper lg |
14,009 |
13,123 |
$1.35M |
| E1390 |
Oxygen concentrator |
12,682 |
12,135 |
$1.31M |
| A4335 |
Incontinence supply |
230,214 |
217,843 |
$1.24M |
| T4528 |
Adult size pull-on xl |
8,902 |
8,467 |
$1.22M |
| B4162 |
Ef ped specmetabolic inherit |
1,522 |
1,382 |
$1.11M |
| A4353 |
Intermittent urinary cath |
2,021 |
1,648 |
$1.03M |
| B4104 |
Additive for enteral formula |
9,039 |
8,073 |
$923K |
| B4088 |
Gastro/jejuno tube, low-pro |
31,445 |
28,839 |
$897K |
| A4351 |
Straight tip urine catheter |
6,615 |
5,890 |
$850K |
| E0466 |
Home vent non-invasive inter |
1,026 |
984 |
$729K |
| A4624 |
Tracheal suction tube |
4,955 |
4,581 |
$687K |
| T4525 |
Adult size pull-on sm |
8,161 |
7,490 |
$648K |
| E0445 |
Oximeter non-invasive |
5,362 |
5,087 |
$647K |
| T4521 |
Adult size brief/diaper sm |
7,278 |
6,518 |
$596K |
| T4524 |
Adult size brief/diaper xl |
4,852 |
4,570 |
$575K |
| B4103 |
Ef ped fluid and electrolyte |
7,875 |
6,631 |
$508K |
| T4535 |
Disposable liner/shield/pad |
18,212 |
17,475 |
$487K |
| A7000 |
Disposable canister for pump |
15,670 |
14,593 |
$471K |
| A4629 |
Tracheostomy care kit |
4,070 |
3,689 |
$371K |
| T4544 |
Adlt disp und/pull on abv xl |
2,016 |
1,982 |
$347K |
| B4036 |
Enteral feed sup kit grav by |
2,372 |
1,933 |
$298K |
| T4533 |
Youth size brief/diaper |
3,270 |
2,993 |
$277K |
| B4100 |
Food thickener oral |
7,610 |
6,927 |
$277K |
| A7002 |
Tubing used w suction pump |
16,178 |
14,883 |
$273K |
| A4605 |
Trach suction cath close sys |
1,985 |
1,833 |
$271K |
| A4385 |
Ost skn barrier sld ext wear |
2,846 |
2,525 |
$249K |
| E0431 |
Portable gaseous 02 |
11,731 |
11,242 |
$223K |
| E0482 |
Cough stimulating device |
886 |
843 |
$222K |
| A4217 |
Sterile water/saline, 500 ml |
3,983 |
3,125 |
$203K |
| A5061 |
Pouch drainable w barrier at |
3,101 |
2,754 |
$197K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,255 |
930 |
$179K |
| A7526 |
Tracheostomy tube collar |
5,069 |
4,505 |
$174K |
| E0776 |
Iv pole |
17,985 |
17,018 |
$157K |
| T4531 |
Ped size pull-on sm/med |
1,552 |
1,341 |
$152K |
| E0600 |
Suction pump portab hom modl |
1,568 |
1,445 |
$141K |
| A4483 |
Moisture exchanger |
2,371 |
1,874 |
$118K |
| B4081 |
Enteral ng tubing w/ stylet |
2,323 |
1,790 |
$108K |
| A7520 |
Trach/laryn tube non-cuffed |
2,726 |
2,504 |
$104K |
| B4082 |
Enteral ng tubing w/o stylet |
2,573 |
2,127 |
$103K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
1,651 |
1,515 |
$98K |
| A4216 |
Sterile water/saline, 10 ml |
4,774 |
3,809 |
$92K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,118 |
995 |
$88K |
| A4628 |
Oropharyngeal suction cath |
14,996 |
14,169 |
$86K |
| A6250 |
Skin seal protect moisturizr |
10,032 |
9,622 |
$85K |
| A4406 |
Pectin based ostomy paste |
5,675 |
5,177 |
$81K |
| T4543 |
Adult disp brief/diap abv xl |
543 |
530 |
$75K |
| A4623 |
Tracheostomy inner cannula |
806 |
738 |
$72K |
| A4927 |
Non-sterile gloves |
9,465 |
8,227 |
$58K |
| A4352 |
Coude tip urinary catheter |
184 |
157 |
$56K |
| E0601 |
Cont airway pressure device |
1,016 |
974 |
$54K |
| A4344 |
Cath indw foley 2 way silicn |
684 |
542 |
$52K |
| A4456 |
Adhesive remover, wipes |
4,433 |
4,022 |
$46K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
679 |
556 |
$46K |
| A4362 |
Solid skin barrier |
1,120 |
1,008 |
$43K |
| A4618 |
Breathing circuits |
2,090 |
1,957 |
$43K |
| A4425 |
Ost pch drain for barrier fl |
840 |
750 |
$43K |
| A7046 |
Repl water chamber, pap dev |
3,381 |
3,185 |
$42K |
| A7521 |
Trach/laryn tube cuffed |
1,036 |
938 |
$41K |
| A4310 |
Insert tray w/o bag/cath |
854 |
681 |
$40K |
| A5120 |
Skin barrier, wipe or swab |
7,006 |
5,954 |
$37K |
| T4529 |
Ped size brief/diaper sm/med |
1,010 |
732 |
$36K |
| A4369 |
Skin barrier liquid per oz |
1,112 |
1,010 |
$32K |
| A4357 |
Bedside drainage bag |
2,577 |
2,087 |
$27K |
| E0565 |
Compressor air power source |
893 |
842 |
$26K |
| A4253 |
Blood glucose/reagent strips |
1,235 |
1,138 |
$25K |
| A7003 |
Nebulizer administration set |
13,293 |
12,639 |
$23K |
| A4402 |
Lubricant per ounce |
5,558 |
5,041 |
$23K |
| K0738 |
Portable gas oxygen system |
124 |
119 |
$21K |
| A6402 |
Sterile gauze <= 16 sq in |
1,819 |
1,663 |
$17K |
| A4371 |
Skin barrier powder per oz |
4,376 |
4,024 |
$16K |
| A7034 |
Nasal application device |
208 |
197 |
$12K |
| E0570 |
Nebulizer with compression |
618 |
579 |
$12K |
| A7525 |
Tracheostomy mask |
2,573 |
2,435 |
$12K |
| A4481 |
Tracheostoma filter |
1,243 |
1,110 |
$11K |
| A4247 |
Betadine/iodine swabs/wipes |
1,004 |
760 |
$11K |
| A4349 |
Disposable male external cat |
366 |
299 |
$11K |
| A5062 |
Drnble ostomy pouch w/o barr |
176 |
165 |
$11K |
| A4358 |
Urinary leg or abdomen bag |
1,131 |
939 |
$11K |
| A7038 |
Pos airway pressure filter |
2,476 |
2,339 |
$10K |
| A7015 |
Aerosol mask used w nebulize |
7,853 |
7,554 |
$10K |
| A4322 |
Irrigation syringe |
1,257 |
1,041 |
$9K |
| A4338 |
Indwelling catheter latex |
218 |
172 |
$9K |
| A4424 |
Ost pch drain w bar & filter |
138 |
124 |
$8K |
| A6212 |
Foam drg <=16 sq in w/border |
54 |
50 |
$8K |
| A6257 |
Transparent film <= 16 sq in |
1,056 |
917 |
$7K |
| E0443 |
Portable 02 contents, gas |
464 |
400 |
$6K |
| E0562 |
Humidifier heated used w pap |
452 |
437 |
$5K |
| A4452 |
Waterproof tape |
1,586 |
1,484 |
$5K |
| A4259 |
Lancets per box |
1,106 |
1,059 |
$5K |
| A7012 |
Nebulizer water collec devic |
1,091 |
1,020 |
$5K |
| A7037 |
Pos airway pressure tubing |
453 |
439 |
$4K |
| A6260 |
Wound cleanser any type/size |
85 |
75 |
$3K |
| A5063 |
Drain ostomy pouch w/flange |
56 |
51 |
$3K |
| A4450 |
Non-waterproof tape |
851 |
744 |
$2K |
| L8501 |
Tracheostomy speaking valve |
28 |
28 |
$2K |
| A4245 |
Alcohol wipes per box |
981 |
943 |
$2K |
| A4455 |
Adhesive remover per ounce |
432 |
379 |
$2K |
| A7035 |
Pos airway press headgear |
66 |
57 |
$1K |
| A4213 |
20+ cc syringe only |
272 |
268 |
$872.72 |
| A4332 |
Lube sterile packet |
166 |
146 |
$731.26 |
| A7039 |
Filter, non disposable w pap |
239 |
231 |
$618.51 |
| A4394 |
Ostomy pouch liq deodorant |
167 |
131 |
$376.47 |
| A9270 |
Non-covered item or service |
4,451 |
1,858 |
$232.74 |
| A6453 |
Self-adher band w <3"/yd |
172 |
152 |
$137.84 |
| A7013 |
Disposable compressor filter |
45 |
45 |
$45.43 |
| A7509 |
Heat & moisture exchange sys |
107 |
101 |
$26.46 |