| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
6,944 |
5,100 |
$1.63M |
| E0465 |
Home vent invasive interface |
2,618 |
1,496 |
$1.58M |
| E1390 |
Oxygen concentrator |
20,858 |
17,712 |
$1.32M |
| E0431 |
Portable gaseous 02 |
15,758 |
13,416 |
$800K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,566 |
1,332 |
$306K |
| E0445 |
Oximeter non-invasive |
1,327 |
1,254 |
$305K |
| B9002 |
Enter nutr inf pump any type |
2,648 |
2,189 |
$194K |
| E0601 |
Cont airway pressure device |
4,400 |
3,790 |
$173K |
| K0001 |
Standard wheelchair |
6,820 |
6,005 |
$152K |
| A7030 |
Cpap full face mask |
1,698 |
1,369 |
$139K |
| A4624 |
Tracheal suction tube |
1,256 |
954 |
$134K |
| E0570 |
Nebulizer with compression |
3,581 |
3,445 |
$119K |
| B9998 |
Enteral supp not otherwise c |
4,799 |
3,069 |
$104K |
| A7526 |
Tracheostomy tube collar |
3,364 |
2,387 |
$92K |
| E0143 |
Walker folding wheeled w/o s |
2,355 |
2,123 |
$87K |
| B4152 |
Ef calorie dense>/=1.5kcal |
509 |
417 |
$84K |
| A7507 |
Integrated filter & holder |
1,400 |
1,105 |
$82K |
| E0562 |
Humidifier heated used w pap |
1,953 |
1,663 |
$79K |
| A4217 |
Sterile water/saline, 500 ml |
2,116 |
1,246 |
$66K |
| B4149 |
Ef blenderized foods |
112 |
102 |
$59K |
| K0195 |
Elevating whlchair leg rests |
4,892 |
4,335 |
$59K |
| B4150 |
Ef complet w/intact nutrient |
376 |
290 |
$53K |
| A4606 |
Oxygen probe used w oximeter |
2,144 |
1,409 |
$51K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,892 |
1,646 |
$50K |
| A4604 |
Tubing with heating element |
2,422 |
2,008 |
$49K |
| A7046 |
Repl water chamber, pap dev |
2,477 |
2,013 |
$48K |
| A7035 |
Pos airway press headgear |
1,970 |
1,697 |
$42K |
| A7031 |
Replacement facemask interfa |
1,172 |
914 |
$36K |
| E0470 |
Rad w/o backup non-inv intfc |
607 |
457 |
$31K |
| B4161 |
Ef ped hydrolyzed/amino acid |
39 |
37 |
$30K |
| A4605 |
Trach suction cath close sys |
287 |
198 |
$25K |
| E0776 |
Iv pole |
1,701 |
1,547 |
$25K |
| E1399 |
Durable medical equipment mi |
217 |
125 |
$23K |
| A7000 |
Disposable canister for pump |
2,779 |
1,908 |
$22K |
| B4088 |
Gastro/jejuno tube, low-pro |
325 |
275 |
$20K |
| A4520 |
Incontinence garment anytype |
208 |
197 |
$18K |
| E0565 |
Compressor air power source |
1,130 |
907 |
$18K |
| A6402 |
Sterile gauze <= 16 sq in |
2,625 |
2,048 |
$17K |
| A7520 |
Trach/laryn tube non-cuffed |
446 |
344 |
$16K |
| A7034 |
Nasal application device |
286 |
239 |
$15K |
| A7038 |
Pos airway pressure filter |
3,340 |
2,650 |
$14K |
| A7002 |
Tubing used w suction pump |
3,272 |
2,419 |
$13K |
| E0630 |
Patient lift hydraulic |
615 |
506 |
$13K |
| E0600 |
Suction pump portab hom modl |
268 |
256 |
$10K |
| T2028 |
Special supply, nos waiver |
91 |
64 |
$8K |
| A4216 |
Sterile water/saline, 10 ml |
557 |
424 |
$8K |
| A7003 |
Nebulizer administration set |
2,679 |
2,377 |
$7K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
135 |
102 |
$6K |
| K0006 |
Heavy duty wheelchair |
360 |
301 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
825 |
484 |
$5K |
| A7037 |
Pos airway pressure tubing |
99 |
80 |
$3K |
| A4628 |
Oropharyngeal suction cath |
1,049 |
689 |
$2K |
| E0114 |
Crutch underarm pair no wood |
52 |
52 |
$2K |
| A4213 |
20+ cc syringe only |
590 |
460 |
$1K |
| E0149 |
Heavy duty wheeled walker |
194 |
168 |
$1K |
| K0003 |
Lightweight wheelchair |
78 |
64 |
$827.92 |
| Z0020 |
|
227 |
214 |
$808.92 |
| A7521 |
Trach/laryn tube cuffed |
23 |
13 |
$736.98 |
| A7033 |
Replacement nasal pillows |
12 |
12 |
$465.79 |
| A4927 |
Non-sterile gloves |
87 |
63 |
$422.37 |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
16 |
13 |
$350.02 |
| E1392 |
Portable oxygen concentrator |
413 |
379 |
$348.84 |
| A6257 |
Transparent film <= 16 sq in |
14 |
13 |
$266.28 |
| A4660 |
Sphyg/bp app w cuff and stet |
12 |
12 |
$258.06 |
| A7013 |
Disposable compressor filter |
385 |
209 |
$174.35 |
| A7032 |
Replacement nasal cushion |
13 |
12 |
$163.69 |
| A4629 |
Tracheostomy care kit |
31 |
24 |
$147.28 |
| A4649 |
Surgical supplies |
29 |
27 |
$96.50 |
| E1355 |
Oxygen supplies stand/rack |
108 |
104 |
$65.34 |
| A7015 |
Aerosol mask used w nebulize |
47 |
40 |
$2.91 |
| A9900 |
Supply/accessory/service |
63 |
22 |
$0.00 |