| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
932 |
907 |
$917K |
| B4035 |
Enteral feed supp pump per d |
2,249 |
2,181 |
$742K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,283 |
1,260 |
$448K |
| B9998 |
Enteral supp not otherwise c |
3,443 |
2,436 |
$367K |
| A4554 |
Disposable underpads |
4,894 |
4,741 |
$152K |
| T4534 |
Youth size pull-on |
1,279 |
1,219 |
$143K |
| T4532 |
Ped size pull-on lg |
930 |
875 |
$130K |
| T4530 |
Ped size brief/diaper lg |
1,317 |
1,269 |
$127K |
| B9002 |
Enter nutr inf pump any type |
403 |
395 |
$112K |
| E1390 |
Oxygen concentrator |
604 |
592 |
$84K |
| A4322 |
Irrigation syringe |
1,908 |
1,689 |
$57K |
| A4606 |
Oxygen probe used w oximeter |
385 |
363 |
$48K |
| A4927 |
Non-sterile gloves |
5,492 |
5,307 |
$41K |
| E0445 |
Oximeter non-invasive |
116 |
106 |
$41K |
| A4335 |
Incontinence supply |
6,510 |
6,188 |
$36K |
| A7000 |
Disposable canister for pump |
538 |
509 |
$34K |
| T4526 |
Adult size pull-on med |
260 |
245 |
$32K |
| A4657 |
Syringe w/wo needle |
2,145 |
2,106 |
$28K |
| A6402 |
Sterile gauze <= 16 sq in |
1,630 |
1,522 |
$27K |
| B4149 |
Ef blenderized foods |
67 |
66 |
$27K |
| A6250 |
Skin seal protect moisturizr |
3,079 |
2,844 |
$26K |
| T4522 |
Adult size brief/diaper med |
273 |
272 |
$25K |
| T4521 |
Adult size brief/diaper sm |
179 |
176 |
$18K |
| E0431 |
Portable gaseous 02 |
661 |
641 |
$16K |
| T4525 |
Adult size pull-on sm |
161 |
155 |
$16K |
| A7002 |
Tubing used w suction pump |
549 |
533 |
$12K |
| A4450 |
Non-waterproof tape |
1,437 |
1,356 |
$8K |
| B4155 |
Ef incomplete/modular |
12 |
12 |
$8K |
| T4527 |
Adult size pull-on lg |
53 |
49 |
$7K |
| A9901 |
Delivery/set up/dispensing |
13 |
13 |
$6K |
| A4628 |
Oropharyngeal suction cath |
656 |
639 |
$5K |
| A7003 |
Nebulizer administration set |
948 |
925 |
$4K |
| A4213 |
20+ cc syringe only |
398 |
386 |
$3K |
| A7013 |
Disposable compressor filter |
26 |
26 |
$27.83 |