| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L8699 |
Prosthetic implant nos |
466 |
373 |
$1.36M |
| E1399 |
Durable medical equipment mi |
1,886 |
1,351 |
$782K |
| E1390 |
Oxygen concentrator |
17,327 |
13,940 |
$765K |
| E0260 |
Hosp bed semi-electr w/ matt |
21,887 |
20,459 |
$553K |
| B4035 |
Enteral feed supp pump per d |
8,285 |
7,684 |
$431K |
| A4353 |
Intermittent urinary cath |
4,443 |
2,169 |
$422K |
| E0424 |
Stationary compressed gas 02 |
5,428 |
4,569 |
$388K |
| B4154 |
Ef spec metabolic noninherit |
2,520 |
2,249 |
$308K |
| B4153 |
Ef hydrolyzed/amino acids |
1,553 |
1,375 |
$243K |
| E0601 |
Cont airway pressure device |
12,756 |
12,262 |
$227K |
| E0431 |
Portable gaseous 02 |
10,122 |
8,507 |
$225K |
| K0001 |
Standard wheelchair |
20,279 |
18,729 |
$216K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,853 |
2,595 |
$209K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
8,634 |
7,477 |
$208K |
| B9998 |
Enteral supp not otherwise c |
317 |
257 |
$199K |
| E1392 |
Portable oxygen concentrator |
402 |
247 |
$187K |
| A5063 |
Drain ostomy pouch w/flange |
9,173 |
7,226 |
$173K |
| E0471 |
Rad w/backup non inv intrfc |
1,604 |
1,505 |
$160K |
| B9002 |
Enter nutr inf pump any type |
7,793 |
7,399 |
$155K |
| E0465 |
Home vent invasive interface |
623 |
600 |
$148K |
| A7030 |
Cpap full face mask |
4,520 |
4,284 |
$144K |
| A7034 |
Nasal application device |
5,507 |
5,252 |
$88K |
| A4624 |
Tracheal suction tube |
2,667 |
1,907 |
$82K |
| E0163 |
Commode chair with fixed arm |
3,314 |
3,090 |
$79K |
| A4253 |
Blood glucose/reagent strips |
5,444 |
4,198 |
$77K |
| E0562 |
Humidifier heated used w pap |
16,211 |
15,515 |
$74K |
| E0185 |
Gel pressure mattress pad |
1,799 |
1,689 |
$74K |
| A4629 |
Tracheostomy care kit |
2,254 |
1,824 |
$64K |
| E0135 |
Walker folding adjust/fixed |
3,447 |
3,215 |
$63K |
| B4161 |
Ef ped hydrolyzed/amino acid |
449 |
407 |
$58K |
| E0143 |
Walker folding wheeled w/o s |
1,877 |
1,733 |
$57K |
| E0303 |
Hosp bed hvy dty xtra wide |
956 |
895 |
$55K |
| A7035 |
Pos airway press headgear |
9,431 |
9,001 |
$51K |
| B4034 |
Enter feed supkit syr by day |
2,723 |
2,408 |
$50K |
| A7037 |
Pos airway pressure tubing |
9,731 |
9,268 |
$47K |
| A5131 |
Appliance cleaner |
5,921 |
5,212 |
$47K |
| E0470 |
Rad w/o backup non-inv intfc |
2,049 |
1,974 |
$44K |
| A4351 |
Straight tip urine catheter |
571 |
476 |
$41K |
| A4406 |
Pectin based ostomy paste |
12,731 |
7,104 |
$40K |
| K0195 |
Elevating whlchair leg rests |
6,075 |
5,409 |
$38K |
| E0973 |
W/ch access det adj armrest |
3,652 |
2,412 |
$38K |
| K0006 |
Heavy duty wheelchair |
993 |
932 |
$35K |
| E0776 |
Iv pole |
7,908 |
7,521 |
$29K |
| E0630 |
Patient lift hydraulic |
1,050 |
972 |
$26K |
| A7038 |
Pos airway pressure filter |
17,942 |
17,023 |
$25K |
| E0600 |
Suction pump portab hom modl |
2,497 |
2,280 |
$23K |
| A4452 |
Waterproof tape |
5,393 |
4,748 |
$23K |
| A4407 |
Ext wear ost skn barr <=4sq" |
406 |
386 |
$23K |
| E0156 |
Walker seat attachment |
1,237 |
1,153 |
$22K |
| B4150 |
Ef complet w/intact nutrient |
560 |
516 |
$20K |
| E0181 |
Press pad alternating w/ pum |
3,204 |
2,993 |
$17K |
| B4088 |
Gastro/jejuno tube, low-pro |
192 |
135 |
$15K |
| A4259 |
Lancets per box |
5,506 |
4,192 |
$15K |
| E0607 |
Blood glucose monitor home |
2,171 |
1,859 |
$14K |
| A4456 |
Adhesive remover, wipes |
6,683 |
5,816 |
$14K |
| A5061 |
Pouch drainable w barrier at |
740 |
641 |
$12K |
| E0240 |
Bath/shower chair |
1,760 |
1,613 |
$11K |
| A5120 |
Skin barrier, wipe or swab |
6,648 |
5,807 |
$11K |
| A7526 |
Tracheostomy tube collar |
634 |
484 |
$11K |
| A4427 |
Ost pch drain/barr lk flng/f |
448 |
322 |
$10K |
| E0439 |
Stationary liquid 02 |
54 |
53 |
$10K |
| A4371 |
Skin barrier powder per oz |
6,786 |
5,895 |
$9K |
| A7039 |
Filter, non disposable w pap |
3,307 |
3,109 |
$9K |
| E0186 |
Air pressure mattress |
343 |
294 |
$9K |
| A7000 |
Disposable canister for pump |
2,303 |
2,050 |
$8K |
| E0277 |
Powered pres-redu air mattrs |
235 |
200 |
$7K |
| B4087 |
Gastro/jejuno tube, std |
217 |
150 |
$6K |
| A7002 |
Tubing used w suction pump |
2,040 |
1,813 |
$6K |
| A7036 |
Pos airway press chinstrap |
2,517 |
2,404 |
$5K |
| A4367 |
Ostomy belt |
3,079 |
2,676 |
$5K |
| E0570 |
Nebulizer with compression |
404 |
355 |
$4K |
| A4385 |
Ost skn barrier sld ext wear |
162 |
146 |
$3K |
| A7046 |
Repl water chamber, pap dev |
1,535 |
1,449 |
$3K |
| K0003 |
Lightweight wheelchair |
207 |
191 |
$3K |
| A4258 |
Lancet device each |
1,687 |
1,415 |
$2K |
| E0935 |
Cont pas motion exercise dev |
53 |
24 |
$2K |
| A4628 |
Oropharyngeal suction cath |
99 |
29 |
$1K |
| A4419 |
Ost pch for bar w flange/flt |
59 |
49 |
$1K |
| E0105 |
Cane adjust/fixed quad/3 pro |
34 |
24 |
$1K |
| E0434 |
Portable liquid 02 |
41 |
41 |
$952.97 |
| E0261 |
Hosp bed semi-electr w/o mat |
101 |
65 |
$829.05 |
| A4450 |
Non-waterproof tape |
186 |
182 |
$811.60 |
| E1038 |
Transport chair pt wt<=300lb |
104 |
80 |
$726.30 |
| A4357 |
Bedside drainage bag |
417 |
359 |
$650.76 |
| E0100 |
Cane adjust/fixed with tip |
33 |
25 |
$535.16 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
28 |
25 |
$524.88 |
| A4369 |
Skin barrier liquid per oz |
232 |
102 |
$413.60 |
| E0114 |
Crutch underarm pair no wood |
12 |
12 |
$399.91 |
| A4349 |
Disposable male external cat |
69 |
24 |
$354.00 |
| A4927 |
Non-sterile gloves |
255 |
211 |
$187.81 |
| A4216 |
Sterile water/saline, 10 ml |
28 |
25 |
$144.76 |
| A6216 |
Non-sterile gauze<=16 sq in |
420 |
322 |
$115.12 |
| A4615 |
Cannula nasal |
17 |
17 |
$0.00 |
| Q0513 |
Disp fee inhal drugs/30 days |
14 |
13 |
$0.00 |
| E0271 |
Mattress innerspring |
22 |
20 |
$0.00 |
| K0739 |
Repair/svc dme non-oxygen eq |
13 |
12 |
$0.00 |
| A4606 |
Oxygen probe used w oximeter |
13 |
12 |
$0.00 |
| A7003 |
Nebulizer administration set |
14 |
13 |
$0.00 |
| A7525 |
Tracheostomy mask |
32 |
31 |
$0.00 |