| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0784 |
Ext amb infusn pump insulin |
2,307 |
2,289 |
$13.05M |
| A4230 |
Infus insulin pump non needl |
19,960 |
19,209 |
$6.09M |
| A4232 |
Syringe w/needle insulin 3cc |
29,840 |
28,694 |
$1.93M |
| Z5999 |
|
2,386 |
1,254 |
$1.66M |
| A4231 |
Infusion insulin pump needle |
10,001 |
9,596 |
$1.65M |
| 99199 |
|
2,118 |
1,500 |
$967K |
| T4532 |
Ped size pull-on lg |
8,668 |
8,564 |
$315K |
| E1399 |
Durable medical equipment mi |
729 |
637 |
$179K |
| B4035 |
Enteral feed supp pump per d |
2,192 |
2,166 |
$125K |
| B9998 |
Enteral supp not otherwise c |
3,430 |
3,200 |
$123K |
| 99429 |
|
285 |
211 |
$119K |
| T4530 |
Ped size brief/diaper lg |
4,154 |
4,134 |
$102K |
| T4541 |
Large disposable underpad |
30,732 |
30,529 |
$99K |
| E1390 |
Oxygen concentrator |
30,064 |
29,903 |
$89K |
| T4522 |
Adult size brief/diaper med |
5,278 |
5,267 |
$72K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,235 |
1,199 |
$70K |
| T4523 |
Adult size brief/diaper lg |
5,510 |
5,485 |
$65K |
| A9276 |
Disposable sensor, cgm sys |
172 |
152 |
$54K |
| K0001 |
Standard wheelchair |
18,604 |
18,422 |
$47K |
| E0471 |
Rad w/backup non inv intrfc |
683 |
612 |
$46K |
| E0431 |
Portable gaseous 02 |
30,092 |
29,936 |
$38K |
| A4351 |
Straight tip urine catheter |
2,652 |
2,636 |
$32K |
| A4322 |
Irrigation syringe |
4,067 |
3,854 |
$31K |
| T4535 |
Disposable liner/shield/pad |
11,624 |
11,429 |
$30K |
| T4521 |
Adult size brief/diaper sm |
1,071 |
1,067 |
$23K |
| K0195 |
Elevating whlchair leg rests |
6,514 |
6,389 |
$20K |
| T4524 |
Adult size brief/diaper xl |
3,260 |
3,246 |
$17K |
| K0554 |
Ther cgm receiver/monitor |
92 |
92 |
$16K |
| E0601 |
Cont airway pressure device |
33,595 |
33,392 |
$16K |
| T4526 |
Adult size pull-on med |
7,300 |
7,269 |
$13K |
| A6402 |
Sterile gauze <= 16 sq in |
4,304 |
4,245 |
$12K |
| A4335 |
Incontinence supply |
12,101 |
12,033 |
$12K |
| A6250 |
Skin seal protect moisturizr |
11,229 |
11,164 |
$12K |
| E0143 |
Walker folding wheeled w/o s |
4,997 |
4,979 |
$11K |
| A6549 |
Grad com garm noc day use |
168 |
133 |
$10K |
| T4525 |
Adult size pull-on sm |
2,917 |
2,888 |
$9K |
| T4537 |
Reusable underpad bed size |
1,202 |
1,166 |
$9K |
| T4527 |
Adult size pull-on lg |
6,573 |
6,529 |
$8K |
| E0295 |
Hosp bed semi-elect w/o matt |
2,429 |
2,429 |
$8K |
| A6454 |
Self-adher band w>=3" <5"/yd |
228 |
214 |
$8K |
| E0118 |
Crutch substitute |
42 |
41 |
$8K |
| E0562 |
Humidifier heated used w pap |
34,082 |
33,877 |
$7K |
| E0600 |
Suction pump portab hom modl |
811 |
810 |
$7K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,439 |
1,419 |
$7K |
| T4528 |
Adult size pull-on xl |
5,265 |
5,241 |
$7K |
| A4456 |
Adhesive remover, wipes |
1,065 |
975 |
$6K |
| L1832 |
Ko adj jnt pos r sup pre cst |
28 |
26 |
$6K |
| A4927 |
Non-sterile gloves |
4,300 |
4,275 |
$6K |
| E1353 |
Oxygen supplies regulator |
2,095 |
2,086 |
$6K |
| L3908 |
Who cock-up nonmolde pre ots |
150 |
107 |
$6K |
| E0245 |
Tub stool or bench |
1,921 |
1,919 |
$5K |
| E1355 |
Oxygen supplies stand/rack |
2,073 |
2,070 |
$4K |
| A4353 |
Intermittent urinary cath |
376 |
357 |
$4K |
| A4670 |
Automatic bp monitor, dial |
215 |
210 |
$4K |
| A4425 |
Ost pch drain for barrier fl |
1,332 |
1,318 |
$4K |
| A4385 |
Ost skn barrier sld ext wear |
1,129 |
1,121 |
$3K |
| A5063 |
Drain ostomy pouch w/flange |
872 |
866 |
$3K |
| A7000 |
Disposable canister for pump |
759 |
756 |
$3K |
| A7002 |
Tubing used w suction pump |
743 |
742 |
$3K |
| K0003 |
Lightweight wheelchair |
2,751 |
2,733 |
$3K |
| E0163 |
Commode chair with fixed arm |
958 |
956 |
$3K |
| E0470 |
Rad w/o backup non-inv intfc |
2,909 |
2,900 |
$3K |
| A4406 |
Pectin based ostomy paste |
1,338 |
1,331 |
$3K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
14 |
13 |
$3K |
| E0247 |
Trans bench w/wo comm open |
587 |
586 |
$2K |
| A4628 |
Oropharyngeal suction cath |
571 |
561 |
$2K |
| K0553 |
Ther cgm supply allowance |
48 |
47 |
$2K |
| L4360 |
Pneumat walking boot pre cst |
13 |
12 |
$2K |
| A7030 |
Cpap full face mask |
3,543 |
3,541 |
$2K |
| E0570 |
Nebulizer with compression |
4,132 |
4,129 |
$2K |
| A7034 |
Nasal application device |
3,122 |
3,122 |
$2K |
| A4357 |
Bedside drainage bag |
554 |
541 |
$2K |
| A5120 |
Skin barrier, wipe or swab |
1,327 |
1,311 |
$2K |
| K0007 |
Extra heavy duty wheelchair |
785 |
779 |
$2K |
| E0630 |
Patient lift hydraulic |
1,054 |
1,043 |
$2K |
| A4452 |
Waterproof tape |
1,766 |
1,758 |
$1K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,238 |
1,229 |
$1K |
| A7035 |
Pos airway press headgear |
6,967 |
6,961 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
1,499 |
1,489 |
$1K |
| A7037 |
Pos airway pressure tubing |
6,663 |
6,660 |
$1K |
| E0271 |
Mattress innerspring |
2,483 |
2,483 |
$1K |
| E0305 |
Rails bed side half length |
2,510 |
2,510 |
$1K |
| A6260 |
Wound cleanser any type/size |
81 |
77 |
$977.22 |
| A4663 |
Dialysis blood pressure cuff |
149 |
141 |
$952.11 |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
153 |
152 |
$921.00 |
| E0156 |
Walker seat attachment |
2,263 |
2,261 |
$903.26 |
| E0971 |
Wheelchair anti-tipping devi |
39 |
38 |
$869.52 |
| A6446 |
Conform band s w>=3" <5"/yd |
755 |
748 |
$846.54 |
| A4394 |
Ostomy pouch liq deodorant |
884 |
879 |
$842.72 |
| E0114 |
Crutch underarm pair no wood |
450 |
450 |
$804.66 |
| E0260 |
Hosp bed semi-electr w/ matt |
1,707 |
1,689 |
$735.61 |
| A4604 |
Tubing with heating element |
25 |
25 |
$722.41 |
| E0730 |
Tens four lead |
5,599 |
5,574 |
$665.60 |
| A4624 |
Tracheal suction tube |
79 |
79 |
$588.62 |
| A4402 |
Lubricant per ounce |
1,386 |
1,375 |
$468.44 |
| A7038 |
Pos airway pressure filter |
7,827 |
7,820 |
$300.61 |
| A4358 |
Urinary leg or abdomen bag |
206 |
205 |
$232.30 |
| A7046 |
Repl water chamber, pap dev |
627 |
627 |
$210.99 |
| A7039 |
Filter, non disposable w pap |
2,026 |
2,016 |
$203.41 |
| A7015 |
Aerosol mask used w nebulize |
3,778 |
3,757 |
$168.52 |
| E0165 |
Commode chair with detacharm |
36 |
36 |
$160.00 |
| B4150 |
Ef complet w/intact nutrient |
909 |
845 |
$103.91 |
| E0277 |
Powered pres-redu air mattrs |
63 |
63 |
$55.47 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
411 |
406 |
$49.34 |
| A7003 |
Nebulizer administration set |
68 |
68 |
$21.68 |
| A4450 |
Non-waterproof tape |
1,137 |
1,131 |
$13.95 |
| A4371 |
Skin barrier powder per oz |
490 |
484 |
$4.64 |
| A4362 |
Solid skin barrier |
192 |
192 |
$0.00 |
| 95811 |
|
138 |
116 |
$0.00 |
| 95810 |
|
163 |
146 |
$0.00 |
| A7036 |
Pos airway press chinstrap |
13 |
13 |
$0.00 |
| A4407 |
Ext wear ost skn barr <=4sq" |
12 |
12 |
$0.00 |
| E0565 |
Compressor air power source |
24 |
24 |
$0.00 |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,751 |
1,728 |
$0.00 |
| B4152 |
Ef calorie dense>/=1.5kcal |
652 |
641 |
$0.00 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,539 |
3,353 |
$0.00 |
| E0100 |
Cane adjust/fixed with tip |
127 |
127 |
$0.00 |