| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
4,129 |
4,049 |
$2.30M |
| B4157 |
Ef special metabolic inherit |
1,150 |
1,035 |
$2.09M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,068 |
5,947 |
$1.86M |
| B4155 |
Ef incomplete/modular |
1,489 |
1,121 |
$864K |
| B4162 |
Ef ped specmetabolic inherit |
273 |
263 |
$421K |
| B4150 |
Ef complet w/intact nutrient |
3,940 |
3,867 |
$408K |
| B4154 |
Ef spec metabolic noninherit |
2,431 |
2,318 |
$355K |
| B9998 |
Enteral supp not otherwise c |
397 |
294 |
$258K |
| T4527 |
Adult size pull-on lg |
2,813 |
2,751 |
$204K |
| T4535 |
Disposable liner/shield/pad |
4,593 |
4,407 |
$194K |
| T4528 |
Adult size pull-on xl |
1,892 |
1,868 |
$169K |
| T4526 |
Adult size pull-on med |
2,158 |
2,117 |
$150K |
| T4541 |
Large disposable underpad |
3,644 |
3,576 |
$105K |
| E1399 |
Durable medical equipment mi |
254 |
239 |
$85K |
| B4035 |
Enteral feed supp pump per d |
439 |
433 |
$78K |
| A4670 |
Automatic bp monitor, dial |
1,704 |
1,668 |
$75K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,635 |
1,621 |
$66K |
| T4544 |
Adlt disp und/pull on abv xl |
335 |
327 |
$53K |
| B4158 |
Ef ped complete intact nut |
104 |
104 |
$50K |
| B4088 |
Gastro/jejuno tube, low-pro |
465 |
297 |
$32K |
| A4927 |
Non-sterile gloves |
2,086 |
2,024 |
$31K |
| T4525 |
Adult size pull-on sm |
372 |
365 |
$30K |
| E0245 |
Tub stool or bench |
809 |
777 |
$27K |
| B4087 |
Gastro/jejuno tube, std |
137 |
72 |
$15K |
| A4456 |
Adhesive remover, wipes |
2,414 |
2,343 |
$15K |
| T4537 |
Reusable underpad bed size |
872 |
866 |
$15K |
| T4522 |
Adult size brief/diaper med |
205 |
201 |
$15K |
| S5165 |
Home modifications per serv |
34 |
33 |
$15K |
| B4152 |
Ef calorie dense>/=1.5kcal |
71 |
71 |
$13K |
| T4524 |
Adult size brief/diaper xl |
118 |
114 |
$12K |
| E0143 |
Walker folding wheeled w/o s |
528 |
496 |
$11K |
| E0445 |
Oximeter non-invasive |
15 |
15 |
$11K |
| K0002 |
Stnd hemi (low seat) whlchr |
134 |
129 |
$11K |
| E0570 |
Nebulizer with compression |
227 |
210 |
$11K |
| A9900 |
Supply/accessory/service |
27 |
27 |
$10K |
| B4149 |
Ef blenderized foods |
15 |
12 |
$9K |
| B9002 |
Enter nutr inf pump any type |
12 |
12 |
$9K |
| T4534 |
Youth size pull-on |
49 |
49 |
$7K |
| E0241 |
Bath tub wall rail |
188 |
178 |
$6K |
| E0244 |
Toilet seat raised |
119 |
108 |
$6K |
| A6250 |
Skin seal protect moisturizr |
527 |
510 |
$6K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
77 |
77 |
$6K |
| T4523 |
Adult size brief/diaper lg |
62 |
61 |
$5K |
| E0163 |
Commode chair with fixed arm |
139 |
131 |
$3K |
| A4213 |
20+ cc syringe only |
268 |
267 |
$3K |
| A4322 |
Irrigation syringe |
263 |
260 |
$3K |
| A4930 |
Sterile, gloves per pair |
126 |
124 |
$2K |
| E0246 |
Transfer tub rail attachment |
26 |
20 |
$2K |
| E0156 |
Walker seat attachment |
440 |
400 |
$2K |
| A4452 |
Waterproof tape |
410 |
406 |
$2K |
| T4530 |
Ped size brief/diaper lg |
13 |
12 |
$2K |
| E0100 |
Cane adjust/fixed with tip |
282 |
272 |
$2K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
25 |
25 |
$2K |
| A6260 |
Wound cleanser any type/size |
87 |
78 |
$2K |
| E0310 |
Rails bed side full length |
44 |
41 |
$2K |
| A4320 |
Irrigation tray |
51 |
51 |
$1K |
| E0627 |
Seat lift mech, electric any |
19 |
19 |
$895.78 |
| E0630 |
Patient lift hydraulic |
64 |
63 |
$780.73 |
| E0105 |
Cane adjust/fixed quad/3 pro |
32 |
31 |
$593.01 |
| A6530 |
Compression stocking bk18-30 |
23 |
12 |
$499.79 |
| A6449 |
Lt compres band >=3" <5"/yd |
54 |
51 |
$479.16 |
| A9999 |
Dme supply or accessory, nos |
12 |
12 |
$246.17 |
| A9286 |
Any hygienic item, device |
17 |
17 |
$191.78 |
| E0240 |
Bath/shower chair |
12 |
12 |
$144.69 |