| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Noc retail items andsupplies |
73,662 |
68,846 |
$2.61M |
| T4543 |
Adult disp brief/diap abv xl |
3,798 |
3,474 |
$2.24M |
| T4535 |
Disposable liner/shield/pad |
32,120 |
30,409 |
$1.90M |
| T4527 |
Adult size pull-on lg |
13,072 |
12,430 |
$1.75M |
| T4526 |
Adult size pull-on med |
13,770 |
13,104 |
$1.61M |
| T4541 |
Large disposable underpad |
36,364 |
34,752 |
$1.53M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,355 |
5,446 |
$1.32M |
| B4150 |
Ef complet w/intact nutrient |
9,160 |
7,977 |
$1.07M |
| T4528 |
Adult size pull-on xl |
7,660 |
7,304 |
$1.02M |
| B4161 |
Ef ped hydrolyzed/amino acid |
2,222 |
1,820 |
$1.00M |
| T4534 |
Youth size pull-on |
7,130 |
6,727 |
$983K |
| T4537 |
Reusable underpad bed size |
17,788 |
16,494 |
$839K |
| A9999 |
Dme supply or accessory, nos |
26,357 |
14,910 |
$814K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,905 |
4,188 |
$650K |
| A4927 |
Non-sterile gloves |
32,704 |
30,047 |
$637K |
| A6250 |
Skin seal protect moisturizr |
61,784 |
32,572 |
$578K |
| E1390 |
Oxygen concentrator |
7,602 |
6,308 |
$557K |
| B4154 |
Ef spec metabolic noninherit |
3,432 |
3,040 |
$541K |
| T4523 |
Adult size brief/diaper lg |
3,431 |
3,175 |
$428K |
| B9998 |
Enteral supp not otherwise c |
3,056 |
1,123 |
$421K |
| T4524 |
Adult size brief/diaper xl |
2,589 |
2,424 |
$374K |
| B4035 |
Enteral feed supp pump per d |
1,398 |
1,229 |
$304K |
| T4522 |
Adult size brief/diaper med |
2,572 |
2,416 |
$280K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,436 |
1,191 |
$213K |
| B4100 |
Food thickener oral |
1,246 |
1,049 |
$181K |
| E1392 |
Portable oxygen concentrator |
4,818 |
4,061 |
$174K |
| T4530 |
Ped size brief/diaper lg |
1,684 |
1,582 |
$165K |
| A4351 |
Straight tip urine catheter |
1,376 |
1,151 |
$132K |
| A6530 |
Compression stocking bk18-30 |
2,790 |
1,671 |
$131K |
| T4544 |
Adlt disp und/pull on abv xl |
680 |
663 |
$125K |
| A7030 |
Cpap full face mask |
1,215 |
1,059 |
$111K |
| B4034 |
Enter feed supkit syr by day |
1,091 |
923 |
$106K |
| A4335 |
Incontinence supply |
10,867 |
7,503 |
$82K |
| A4604 |
Tubing with heating element |
1,925 |
1,651 |
$66K |
| E0601 |
Cont airway pressure device |
1,151 |
835 |
$62K |
| A7034 |
Nasal application device |
982 |
829 |
$60K |
| B4158 |
Ef ped complete intact nut |
301 |
262 |
$57K |
| A6533 |
Gc stocking thighlngth 18-30 |
376 |
320 |
$56K |
| A7031 |
Replacement facemask interfa |
1,603 |
1,440 |
$55K |
| E0570 |
Nebulizer with compression |
2,373 |
1,948 |
$54K |
| T4521 |
Adult size brief/diaper sm |
481 |
425 |
$40K |
| E0260 |
Hosp bed semi-electr w/ matt |
356 |
239 |
$38K |
| A7032 |
Replacement nasal cushion |
1,324 |
1,043 |
$32K |
| T4525 |
Adult size pull-on sm |
254 |
239 |
$28K |
| A7035 |
Pos airway press headgear |
1,373 |
1,189 |
$28K |
| A4322 |
Irrigation syringe |
734 |
593 |
$25K |
| E0431 |
Portable gaseous 02 |
1,995 |
1,473 |
$24K |
| A4628 |
Oropharyngeal suction cath |
1,183 |
1,011 |
$23K |
| K0001 |
Standard wheelchair |
703 |
469 |
$22K |
| A7038 |
Pos airway pressure filter |
4,591 |
4,143 |
$17K |
| A7000 |
Disposable canister for pump |
1,326 |
1,204 |
$16K |
| B9002 |
Enter nutr inf pump any type |
82 |
69 |
$15K |
| A7046 |
Repl water chamber, pap dev |
988 |
874 |
$14K |
| E0143 |
Walker folding wheeled w/o s |
289 |
199 |
$13K |
| A4670 |
Automatic bp monitor, dial |
125 |
117 |
$13K |
| A4213 |
20+ cc syringe only |
389 |
355 |
$11K |
| A4357 |
Bedside drainage bag |
1,001 |
840 |
$11K |
| A6402 |
Sterile gauze <= 16 sq in |
949 |
723 |
$9K |
| E0562 |
Humidifier heated used w pap |
59 |
38 |
$9K |
| A7002 |
Tubing used w suction pump |
1,368 |
1,258 |
$8K |
| A7039 |
Filter, non disposable w pap |
1,305 |
1,139 |
$7K |
| E0245 |
Tub stool or bench |
105 |
91 |
$7K |
| E0470 |
Rad w/o backup non-inv intfc |
28 |
25 |
$6K |
| K0003 |
Lightweight wheelchair |
187 |
108 |
$6K |
| E0603 |
Electric breast pump |
15 |
13 |
$5K |
| A4358 |
Urinary leg or abdomen bag |
576 |
509 |
$4K |
| E0630 |
Patient lift hydraulic |
59 |
39 |
$4K |
| B4036 |
Enteral feed sup kit grav by |
28 |
24 |
$3K |
| E0247 |
Trans bench w/wo comm open |
29 |
25 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
86 |
53 |
$2K |
| A7033 |
Replacement nasal pillows |
102 |
80 |
$2K |
| E0156 |
Walker seat attachment |
147 |
100 |
$2K |
| K0004 |
High strength ltwt whlchr |
131 |
68 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
408 |
147 |
$1K |
| A4452 |
Waterproof tape |
88 |
68 |
$972.12 |
| K0738 |
Portable gas oxygen system |
74 |
40 |
$949.77 |
| A4425 |
Ost pch drain for barrier fl |
23 |
13 |
$920.23 |
| A4333 |
Urinary cath anchor device |
95 |
86 |
$891.04 |
| E0244 |
Toilet seat raised |
15 |
15 |
$717.50 |
| A4402 |
Lubricant per ounce |
38 |
36 |
$699.54 |
| E0978 |
W/c acc,saf belt pelv strap |
337 |
208 |
$682.27 |
| K0739 |
Repair/svc dme non-oxygen eq |
27 |
16 |
$550.99 |
| E0973 |
W/ch access det adj armrest |
356 |
113 |
$432.36 |
| A7037 |
Pos airway pressure tubing |
19 |
13 |
$402.90 |
| A4450 |
Non-waterproof tape |
36 |
26 |
$290.40 |
| A4332 |
Lube sterile packet |
26 |
25 |
$236.27 |
| A4615 |
Cannula nasal |
77 |
69 |
$210.00 |
| A4616 |
Tubing (oxygen) per foot |
17 |
13 |
$208.86 |
| A7003 |
Nebulizer administration set |
111 |
106 |
$197.63 |
| A4657 |
Syringe w/wo needle |
16 |
12 |
$186.48 |
| A9901 |
Delivery/set up/dispensing |
336 |
262 |
$152.02 |
| A9900 |
Supply/accessory/service |
38 |
24 |
$41.07 |