| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
3,970 |
3,761 |
$182K |
| E0465 |
Home vent invasive interface |
224 |
109 |
$144K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,132 |
2,938 |
$119K |
| A4927 |
Non-sterile gloves |
4,138 |
3,815 |
$109K |
| T2029 |
Special med equip, noswaiver |
323 |
210 |
$49K |
| B4035 |
Enteral feed supp pump per d |
448 |
320 |
$44K |
| A4217 |
Sterile water/saline, 500 ml |
675 |
517 |
$38K |
| T4528 |
Adult size pull-on xl |
260 |
239 |
$33K |
| A4606 |
Oxygen probe used w oximeter |
208 |
165 |
$30K |
| T4524 |
Adult size brief/diaper xl |
158 |
138 |
$30K |
| T4527 |
Adult size pull-on lg |
193 |
187 |
$23K |
| T4535 |
Disposable liner/shield/pad |
416 |
384 |
$22K |
| E0555 |
Humidifier for use w/ regula |
300 |
112 |
$18K |
| S8189 |
Trach supply noc |
943 |
552 |
$17K |
| B4152 |
Ef calorie dense>/=1.5kcal |
122 |
88 |
$16K |
| K0001 |
Standard wheelchair |
675 |
628 |
$15K |
| T4526 |
Adult size pull-on med |
108 |
104 |
$13K |
| T4523 |
Adult size brief/diaper lg |
97 |
85 |
$12K |
| E1390 |
Oxygen concentrator |
150 |
136 |
$11K |
| A6402 |
Sterile gauze <= 16 sq in |
562 |
469 |
$11K |
| B4150 |
Ef complet w/intact nutrient |
86 |
68 |
$9K |
| A4624 |
Tracheal suction tube |
53 |
26 |
$9K |
| A4357 |
Bedside drainage bag |
425 |
331 |
$8K |
| A4331 |
Extension drainage tubing |
346 |
225 |
$7K |
| T4522 |
Adult size brief/diaper med |
42 |
39 |
$6K |
| E0630 |
Patient lift hydraulic |
140 |
130 |
$6K |
| A7521 |
Trach/laryn tube cuffed |
172 |
129 |
$4K |
| A7526 |
Tracheostomy tube collar |
50 |
38 |
$3K |
| A4310 |
Insert tray w/o bag/cath |
105 |
62 |
$2K |
| A4322 |
Irrigation syringe |
37 |
27 |
$2K |
| A7000 |
Disposable canister for pump |
149 |
96 |
$1K |
| E0431 |
Portable gaseous 02 |
63 |
57 |
$1K |
| A4216 |
Sterile water/saline, 10 ml |
55 |
43 |
$1K |
| A7002 |
Tubing used w suction pump |
169 |
98 |
$666.05 |
| A4628 |
Oropharyngeal suction cath |
88 |
66 |
$443.25 |
| A7003 |
Nebulizer administration set |
101 |
54 |
$283.04 |
| A9270 |
Non-covered item or service |
229 |
139 |
$200.04 |
| A4358 |
Urinary leg or abdomen bag |
19 |
12 |
$116.08 |
| A4657 |
Syringe w/wo needle |
29 |
24 |
$67.91 |
| A4245 |
Alcohol wipes per box |
15 |
13 |
$51.39 |
| A7525 |
Tracheostomy mask |
29 |
24 |
$44.47 |
| A4450 |
Non-waterproof tape |
17 |
14 |
$30.81 |