| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
35,557 |
29,407 |
$8.16M |
| B4161 |
Ef ped hydrolyzed/amino acid |
13,480 |
10,666 |
$4.46M |
| B4149 |
Ef blenderized foods |
11,485 |
7,669 |
$3.44M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
25,943 |
19,784 |
$2.34M |
| B9002 |
Enter nutr inf pump any type |
17,941 |
15,081 |
$1.40M |
| B4088 |
Gastro/jejuno tube, low-pro |
9,668 |
8,771 |
$1.05M |
| B4162 |
Ef ped specmetabolic inherit |
2,217 |
1,673 |
$880K |
| E0445 |
Oximeter non-invasive |
4,274 |
3,957 |
$677K |
| B4155 |
Ef incomplete/modular |
5,006 |
3,451 |
$491K |
| B4036 |
Enteral feed sup kit grav by |
2,634 |
2,242 |
$424K |
| A4606 |
Oxygen probe used w oximeter |
4,432 |
3,552 |
$339K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,834 |
2,188 |
$338K |
| B4100 |
Food thickener oral |
7,371 |
6,735 |
$338K |
| E0431 |
Portable gaseous 02 |
5,606 |
5,085 |
$324K |
| E1390 |
Oxygen concentrator |
4,806 |
4,452 |
$294K |
| E0482 |
Cough stimulating device |
960 |
924 |
$277K |
| B4154 |
Ef spec metabolic noninherit |
813 |
636 |
$265K |
| B4034 |
Enter feed supkit syr by day |
1,968 |
1,691 |
$232K |
| E0443 |
Portable 02 contents, gas |
4,447 |
4,080 |
$211K |
| B4150 |
Ef complet w/intact nutrient |
2,316 |
1,551 |
$211K |
| B4158 |
Ef ped complete intact nut |
1,544 |
1,308 |
$188K |
| A4351 |
Straight tip urine catheter |
1,733 |
1,280 |
$165K |
| E0465 |
Home vent invasive interface |
185 |
160 |
$147K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,057 |
876 |
$130K |
| A4217 |
Sterile water/saline, 500 ml |
2,341 |
1,838 |
$114K |
| E0600 |
Suction pump portab hom modl |
2,392 |
2,228 |
$95K |
| S9342 |
Hit enteral pump diem |
723 |
622 |
$83K |
| B4103 |
Ef ped fluid and electrolyte |
1,174 |
803 |
$74K |
| K0001 |
Standard wheelchair |
3,680 |
3,369 |
$73K |
| A4624 |
Tracheal suction tube |
1,060 |
819 |
$69K |
| K0195 |
Elevating whlchair leg rests |
5,123 |
4,870 |
$69K |
| E0978 |
W/c acc,saf belt pelv strap |
3,973 |
3,570 |
$66K |
| E0776 |
Iv pole |
751 |
722 |
$63K |
| A4344 |
Cath indw foley 2 way silicn |
1,601 |
1,334 |
$63K |
| E0971 |
Wheelchair anti-tipping devi |
3,753 |
3,582 |
$59K |
| B4189 |
Parenteral sol amino acid & |
96 |
27 |
$50K |
| A4628 |
Oropharyngeal suction cath |
4,765 |
2,896 |
$46K |
| E1236 |
Folding ped wc adjustable |
955 |
847 |
$41K |
| A4352 |
Coude tip urinary catheter |
234 |
181 |
$38K |
| E1399 |
Durable medical equipment mi |
2,420 |
1,407 |
$38K |
| E0619 |
Apnea monitor w recorder |
177 |
167 |
$34K |
| A7000 |
Disposable canister for pump |
3,655 |
2,993 |
$33K |
| B4153 |
Ef hydrolyzed/amino acids |
63 |
52 |
$31K |
| A4400 |
Ostomy irrigation set |
543 |
349 |
$30K |
| A7526 |
Tracheostomy tube collar |
779 |
597 |
$24K |
| A6212 |
Foam drg <=16 sq in w/border |
258 |
211 |
$24K |
| E0424 |
Stationary compressed gas 02 |
291 |
282 |
$22K |
| E1226 |
Manual fully reclining back |
663 |
620 |
$20K |
| B4224 |
Parenteral administration ki |
188 |
49 |
$19K |
| A4554 |
Disposable underpads |
76 |
66 |
$17K |
| B4104 |
Additive for enteral formula |
270 |
227 |
$16K |
| A4605 |
Trach suction cath close sys |
268 |
186 |
$16K |
| A4216 |
Sterile water/saline, 10 ml |
588 |
431 |
$13K |
| A7002 |
Tubing used w suction pump |
2,734 |
2,332 |
$13K |
| A4409 |
Ost skn barr convex <=4 sq i |
190 |
143 |
$12K |
| A7503 |
Hmes filter holder or cap |
75 |
69 |
$11K |
| B9998 |
Enteral supp not otherwise c |
826 |
520 |
$10K |
| A4385 |
Ost skn barrier sld ext wear |
258 |
203 |
$9K |
| A4245 |
Alcohol wipes per box |
84 |
70 |
$7K |
| A4322 |
Irrigation syringe |
1,232 |
1,096 |
$7K |
| A4629 |
Tracheostomy care kit |
504 |
412 |
$7K |
| E0781 |
External ambulatory infus pu |
75 |
56 |
$6K |
| A4223 |
Infusion supplies w/o pump |
83 |
38 |
$6K |
| B4220 |
Parenteral supply kit premix |
186 |
49 |
$6K |
| A7038 |
Pos airway pressure filter |
1,189 |
1,018 |
$6K |
| A4402 |
Lubricant per ounce |
2,187 |
1,887 |
$6K |
| A9999 |
Dme supply or accessory, nos |
665 |
528 |
$6K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
83 |
64 |
$5K |
| A6453 |
Self-adher band w <3"/yd |
4,319 |
3,599 |
$5K |
| A5120 |
Skin barrier, wipe or swab |
785 |
618 |
$4K |
| A4371 |
Skin barrier powder per oz |
683 |
576 |
$3K |
| A4221 |
Supp non-insulin inf cath/wk |
160 |
107 |
$3K |
| A4332 |
Lube sterile packet |
1,155 |
943 |
$3K |
| A4425 |
Ost pch drain for barrier fl |
43 |
37 |
$3K |
| E0570 |
Nebulizer with compression |
101 |
100 |
$2K |
| A7005 |
Nondisposable nebulizer set |
164 |
158 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
229 |
176 |
$688.24 |
| A5121 |
Solid skin barrier 6x6 |
41 |
27 |
$623.00 |
| A4458 |
Reusable enema bag |
207 |
173 |
$575.43 |
| E0565 |
Compressor air power source |
12 |
12 |
$428.35 |
| A4456 |
Adhesive remover, wipes |
125 |
80 |
$386.48 |
| A6250 |
Skin seal protect moisturizr |
168 |
128 |
$311.90 |
| A4616 |
Tubing (oxygen) per foot |
254 |
213 |
$231.65 |
| A4213 |
20+ cc syringe only |
90 |
63 |
$161.70 |
| A4369 |
Skin barrier liquid per oz |
51 |
29 |
$150.10 |
| A6216 |
Non-sterile gauze<=16 sq in |
1,516 |
1,269 |
$139.21 |
| A4452 |
Waterproof tape |
123 |
94 |
$40.20 |
| A6217 |
Non-sterile gauze>16<=48 sq |
13 |
12 |
$1.73 |