| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
5,942 |
2,665 |
$2.17M |
| B4035 |
Enteral feed supp pump per d |
4,932 |
4,812 |
$1.30M |
| K0108 |
W/c component-accessory nos |
4,337 |
1,522 |
$843K |
| T4534 |
Youth size pull-on |
7,419 |
7,322 |
$748K |
| B4149 |
Ef blenderized foods |
2,228 |
2,105 |
$717K |
| B4153 |
Ef hydrolyzed/amino acids |
1,136 |
985 |
$606K |
| T4522 |
Adult size brief/diaper med |
5,927 |
5,859 |
$531K |
| T4523 |
Adult size brief/diaper lg |
4,723 |
4,646 |
$521K |
| A6212 |
Foam drg <=16 sq in w/border |
1,317 |
1,225 |
$507K |
| T4541 |
Large disposable underpad |
11,488 |
11,373 |
$464K |
| B4161 |
Ef ped hydrolyzed/amino acid |
739 |
718 |
$448K |
| A4927 |
Non-sterile gloves |
27,533 |
26,624 |
$408K |
| A4335 |
Incontinence supply |
13,124 |
12,763 |
$383K |
| T4526 |
Adult size pull-on med |
4,019 |
3,955 |
$378K |
| A4351 |
Straight tip urine catheter |
2,546 |
2,220 |
$354K |
| T4537 |
Reusable underpad bed size |
9,413 |
9,342 |
$337K |
| T4525 |
Adult size pull-on sm |
3,337 |
3,288 |
$327K |
| E1390 |
Oxygen concentrator |
2,818 |
2,741 |
$264K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,996 |
1,937 |
$264K |
| T4527 |
Adult size pull-on lg |
2,360 |
2,316 |
$254K |
| T4530 |
Ped size brief/diaper lg |
3,263 |
3,215 |
$224K |
| T4532 |
Ped size pull-on lg |
2,485 |
2,458 |
$187K |
| T4524 |
Adult size brief/diaper xl |
1,372 |
1,360 |
$187K |
| A4217 |
Sterile water/saline, 500 ml |
1,942 |
1,694 |
$172K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,638 |
1,545 |
$163K |
| T4528 |
Adult size pull-on xl |
1,412 |
1,397 |
$148K |
| B4088 |
Gastro/jejuno tube, low-pro |
2,072 |
2,039 |
$148K |
| A4624 |
Tracheal suction tube |
561 |
491 |
$146K |
| A4606 |
Oxygen probe used w oximeter |
2,715 |
2,569 |
$143K |
| B4034 |
Enter feed supkit syr by day |
1,129 |
1,085 |
$139K |
| B4150 |
Ef complet w/intact nutrient |
841 |
823 |
$138K |
| T4521 |
Adult size brief/diaper sm |
1,743 |
1,720 |
$125K |
| A7509 |
Heat & moisture exchange sys |
1,913 |
1,587 |
$123K |
| A7526 |
Tracheostomy tube collar |
2,370 |
1,941 |
$119K |
| A7000 |
Disposable canister for pump |
4,151 |
3,737 |
$111K |
| E0600 |
Suction pump portab hom modl |
2,668 |
2,101 |
$109K |
| E0465 |
Home vent invasive interface |
176 |
111 |
$105K |
| E1028 |
W/c manual swingaway |
685 |
405 |
$98K |
| A7520 |
Trach/laryn tube non-cuffed |
1,305 |
994 |
$85K |
| B4155 |
Ef incomplete/modular |
1,265 |
1,153 |
$80K |
| A4344 |
Cath indw foley 2 way silicn |
382 |
288 |
$75K |
| B9002 |
Enter nutr inf pump any type |
783 |
733 |
$68K |
| T4535 |
Disposable liner/shield/pad |
1,786 |
1,681 |
$68K |
| A7002 |
Tubing used w suction pump |
4,447 |
3,894 |
$62K |
| S9999 |
Sales tax |
5,164 |
2,310 |
$61K |
| A4357 |
Bedside drainage bag |
2,734 |
2,280 |
$57K |
| A4385 |
Ost skn barrier sld ext wear |
886 |
737 |
$55K |
| E0431 |
Portable gaseous 02 |
2,684 |
2,566 |
$45K |
| A6402 |
Sterile gauze <= 16 sq in |
2,820 |
2,554 |
$44K |
| A4409 |
Ost skn barr convex <=4 sq i |
322 |
263 |
$39K |
| A4628 |
Oropharyngeal suction cath |
3,318 |
3,044 |
$38K |
| E0601 |
Cont airway pressure device |
361 |
327 |
$33K |
| A6453 |
Self-adher band w <3"/yd |
2,057 |
1,949 |
$32K |
| A4216 |
Sterile water/saline, 10 ml |
1,421 |
1,247 |
$30K |
| A4407 |
Ext wear ost skn barr <=4sq" |
223 |
194 |
$30K |
| A4452 |
Waterproof tape |
1,334 |
1,293 |
$25K |
| A6240 |
Hydrocolld drg filler paste |
440 |
427 |
$21K |
| B4152 |
Ef calorie dense>/=1.5kcal |
135 |
134 |
$20K |
| E0960 |
W/c shoulder harness/straps |
294 |
287 |
$19K |
| E0955 |
Cushioned headrest |
109 |
107 |
$14K |
| A4629 |
Tracheostomy care kit |
151 |
127 |
$13K |
| E0978 |
W/c acc,saf belt pelv strap |
414 |
402 |
$13K |
| E0973 |
W/ch access det adj armrest |
72 |
68 |
$10K |
| A4456 |
Adhesive remover, wipes |
1,557 |
1,290 |
$10K |
| A4332 |
Lube sterile packet |
1,666 |
1,465 |
$8K |
| A4605 |
Trach suction cath close sys |
26 |
26 |
$7K |
| A7038 |
Pos airway pressure filter |
1,106 |
1,080 |
$7K |
| A4604 |
Tubing with heating element |
169 |
164 |
$7K |
| A5120 |
Skin barrier, wipe or swab |
1,587 |
1,315 |
$6K |
| E0565 |
Compressor air power source |
122 |
118 |
$6K |
| A7035 |
Pos airway press headgear |
197 |
192 |
$5K |
| A7004 |
Disposable nebulizer sml vol |
1,593 |
1,430 |
$4K |
| K0040 |
Adjustable angle footplate |
60 |
53 |
$4K |
| A5063 |
Drain ostomy pouch w/flange |
133 |
124 |
$4K |
| E2613 |
Position back cush wd <22in |
13 |
13 |
$3K |
| A6266 |
Impreg gauze no h20/sal/yard |
31 |
30 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
25 |
13 |
$2K |
| A4362 |
Solid skin barrier |
15 |
13 |
$2K |
| A7046 |
Repl water chamber, pap dev |
130 |
130 |
$2K |
| A7525 |
Tracheostomy mask |
750 |
642 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
181 |
160 |
$1K |
| E0971 |
Wheelchair anti-tipping devi |
16 |
16 |
$1K |
| E2231 |
Solid seat support base |
12 |
12 |
$1K |
| A7034 |
Nasal application device |
14 |
14 |
$1K |
| E0950 |
Tray |
12 |
12 |
$951.21 |
| T4533 |
Youth size brief/diaper |
12 |
12 |
$736.51 |
| A4402 |
Lubricant per ounce |
107 |
101 |
$656.17 |
| A6445 |
Conform band s w <3"/yd |
12 |
12 |
$321.51 |
| A6216 |
Non-sterile gauze<=16 sq in |
12 |
12 |
$169.66 |
| A4371 |
Skin barrier powder per oz |
28 |
24 |
$60.14 |