| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1726 |
Makena, 10 mg |
27,741 |
7,165 |
$20.65M |
| B4161 |
Ef ped hydrolyzed/amino acid |
29,689 |
14,722 |
$9.13M |
| B4035 |
Enteral feed supp pump per d |
106,901 |
33,873 |
$7.45M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
41,749 |
21,297 |
$3.86M |
| B4149 |
Ef blenderized foods |
19,463 |
8,930 |
$3.10M |
| J1745 |
Infliximab not biosimil 10mg |
619 |
454 |
$1.50M |
| B4034 |
Enter feed supkit syr by day |
43,358 |
11,230 |
$1.04M |
| B4152 |
Ef calorie dense>/=1.5kcal |
19,297 |
6,846 |
$798K |
| B4153 |
Ef hydrolyzed/amino acids |
5,779 |
1,943 |
$738K |
| S9342 |
Hit enteral pump diem |
67,232 |
3,429 |
$725K |
| B9002 |
Enter nutr inf pump any type |
8,897 |
8,181 |
$513K |
| B4150 |
Ef complet w/intact nutrient |
12,685 |
4,724 |
$494K |
| S9500 |
Hit antibiotic q24h diem |
7,514 |
667 |
$314K |
| B4158 |
Ef ped complete intact nut |
2,305 |
1,259 |
$314K |
| B4088 |
Gastro/jejuno tube, low-pro |
11,403 |
10,208 |
$311K |
| B4155 |
Ef incomplete/modular |
12,566 |
6,838 |
$272K |
| B4154 |
Ef spec metabolic noninherit |
3,947 |
1,652 |
$257K |
| J0585 |
Injection,onabotulinumtoxina |
175 |
117 |
$163K |
| B4103 |
Ef ped fluid and electrolyte |
3,177 |
2,165 |
$140K |
| S9343 |
Hit enteral bolus nurs |
27,019 |
1,541 |
$114K |
| B4162 |
Ef ped specmetabolic inherit |
430 |
319 |
$94K |
| S9502 |
Hit antibiotic q8h diem |
1,791 |
177 |
$91K |
| S9501 |
Hit antibiotic q12h diem |
2,000 |
120 |
$75K |
| S9379 |
Hit noc per diem |
2,057 |
106 |
$71K |
| E0570 |
Nebulizer with compression |
1,033 |
947 |
$62K |
| E0776 |
Iv pole |
5,842 |
5,413 |
$52K |
| T4541 |
Large disposable underpad |
1,392 |
1,244 |
$39K |
| S5501 |
Hit complex cath care |
5,105 |
351 |
$34K |
| E0601 |
Cont airway pressure device |
840 |
767 |
$29K |
| B4185 |
Pn soln nos 10 grams lipids |
227 |
50 |
$24K |
| B4081 |
Enteral ng tubing w/ stylet |
1,382 |
1,063 |
$20K |
| S5502 |
Hit interim cath care |
2,098 |
683 |
$16K |
| E1390 |
Oxygen concentrator |
239 |
214 |
$15K |
| B4100 |
Food thickener oral |
762 |
673 |
$14K |
| A7030 |
Cpap full face mask |
292 |
254 |
$13K |
| A7034 |
Nasal application device |
318 |
271 |
$10K |
| E0562 |
Humidifier heated used w pap |
900 |
826 |
$9K |
| J3370 |
Vancomycin hcl injection |
98 |
40 |
$9K |
| A7005 |
Nondisposable nebulizer set |
637 |
587 |
$7K |
| A4604 |
Tubing with heating element |
256 |
218 |
$5K |
| E0118 |
Crutch substitute |
252 |
235 |
$5K |
| A7035 |
Pos airway press headgear |
316 |
271 |
$3K |
| A4606 |
Oxygen probe used w oximeter |
283 |
98 |
$3K |
| A7037 |
Pos airway pressure tubing |
355 |
305 |
$3K |
| T4530 |
Ped size brief/diaper lg |
49 |
37 |
$3K |
| T4535 |
Disposable liner/shield/pad |
59 |
59 |
$3K |
| A7031 |
Replacement facemask interfa |
152 |
133 |
$3K |
| A7038 |
Pos airway pressure filter |
859 |
747 |
$2K |
| A4628 |
Oropharyngeal suction cath |
86 |
66 |
$2K |
| E0431 |
Portable gaseous 02 |
155 |
140 |
$1K |
| A7046 |
Repl water chamber, pap dev |
269 |
227 |
$1K |
| A7000 |
Disposable canister for pump |
134 |
105 |
$1K |
| E0445 |
Oximeter non-invasive |
31 |
29 |
$973.00 |
| A4223 |
Infusion supplies w/o pump |
394 |
25 |
$941.80 |
| E0600 |
Suction pump portab hom modl |
51 |
39 |
$913.96 |
| B4087 |
Gastro/jejuno tube, std |
45 |
39 |
$892.18 |
| A7002 |
Tubing used w suction pump |
142 |
110 |
$844.48 |
| A7015 |
Aerosol mask used w nebulize |
627 |
580 |
$604.92 |
| A7003 |
Nebulizer administration set |
214 |
163 |
$362.93 |
| K0001 |
Standard wheelchair |
16 |
12 |
$148.26 |
| B4104 |
Additive for enteral formula |
168 |
96 |
$94.80 |