| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
2,755 |
2,698 |
$2.14M |
| E0465 |
Home vent invasive interface |
2,932 |
2,877 |
$1.93M |
| B4035 |
Enteral feed supp pump per d |
6,136 |
5,957 |
$1.67M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,305 |
6,147 |
$1.45M |
| E0466 |
Home vent non-invasive inter |
2,528 |
2,494 |
$955K |
| B9998 |
Enteral supp not otherwise c |
8,596 |
7,156 |
$718K |
| E1390 |
Oxygen concentrator |
7,597 |
7,502 |
$682K |
| A4353 |
Intermittent urinary cath |
1,007 |
919 |
$653K |
| B4149 |
Ef blenderized foods |
1,100 |
1,084 |
$424K |
| A4554 |
Disposable underpads |
12,633 |
12,155 |
$383K |
| A4624 |
Tracheal suction tube |
2,298 |
2,169 |
$341K |
| B4150 |
Ef complet w/intact nutrient |
1,230 |
1,155 |
$324K |
| A4629 |
Tracheostomy care kit |
3,573 |
3,419 |
$303K |
| B4152 |
Ef calorie dense>/=1.5kcal |
768 |
748 |
$295K |
| A4606 |
Oxygen probe used w oximeter |
3,134 |
2,473 |
$290K |
| T4534 |
Youth size pull-on |
2,112 |
2,070 |
$212K |
| B4153 |
Ef hydrolyzed/amino acids |
151 |
150 |
$207K |
| T4522 |
Adult size brief/diaper med |
1,762 |
1,732 |
$185K |
| B4034 |
Enter feed supkit syr by day |
1,200 |
1,191 |
$170K |
| T4530 |
Ped size brief/diaper lg |
1,926 |
1,855 |
$155K |
| A4605 |
Trach suction cath close sys |
1,439 |
1,399 |
$148K |
| A7000 |
Disposable canister for pump |
7,045 |
6,911 |
$139K |
| A7520 |
Trach/laryn tube non-cuffed |
2,038 |
1,947 |
$125K |
| E0431 |
Portable gaseous 02 |
7,184 |
7,075 |
$116K |
| T4523 |
Adult size brief/diaper lg |
902 |
889 |
$97K |
| T4524 |
Adult size brief/diaper xl |
641 |
625 |
$89K |
| A7002 |
Tubing used w suction pump |
7,108 |
6,901 |
$87K |
| A7526 |
Tracheostomy tube collar |
3,943 |
3,728 |
$86K |
| E0445 |
Oximeter non-invasive |
467 |
450 |
$71K |
| A4335 |
Incontinence supply |
13,696 |
13,114 |
$70K |
| T1999 |
Noc retail items andsupplies |
14,192 |
7,380 |
$64K |
| A7521 |
Trach/laryn tube cuffed |
884 |
845 |
$51K |
| A4322 |
Irrigation syringe |
5,822 |
5,695 |
$51K |
| E0482 |
Cough stimulating device |
206 |
206 |
$47K |
| T4527 |
Adult size pull-on lg |
500 |
486 |
$46K |
| A6216 |
Non-sterile gauze<=16 sq in |
7,291 |
6,863 |
$44K |
| T4532 |
Ped size pull-on lg |
329 |
325 |
$41K |
| A4217 |
Sterile water/saline, 500 ml |
1,094 |
974 |
$38K |
| A4623 |
Tracheostomy inner cannula |
758 |
722 |
$36K |
| A4628 |
Oropharyngeal suction cath |
6,813 |
6,609 |
$34K |
| T4535 |
Disposable liner/shield/pad |
1,142 |
1,087 |
$33K |
| T4526 |
Adult size pull-on med |
339 |
331 |
$30K |
| A4216 |
Sterile water/saline, 10 ml |
2,162 |
2,070 |
$30K |
| A9900 |
Supply/accessory/service |
1,618 |
1,341 |
$26K |
| A4927 |
Non-sterile gloves |
3,793 |
3,711 |
$24K |
| B4155 |
Ef incomplete/modular |
152 |
151 |
$22K |
| B9002 |
Enter nutr inf pump any type |
31 |
30 |
$20K |
| A7003 |
Nebulizer administration set |
5,629 |
5,520 |
$18K |
| A4481 |
Tracheostoma filter |
1,126 |
1,000 |
$14K |
| T4521 |
Adult size brief/diaper sm |
102 |
102 |
$10K |
| A4402 |
Lubricant per ounce |
1,862 |
1,850 |
$9K |
| E0601 |
Cont airway pressure device |
222 |
215 |
$9K |
| A4450 |
Non-waterproof tape |
5,676 |
5,624 |
$8K |
| T4528 |
Adult size pull-on xl |
59 |
55 |
$7K |
| A7525 |
Tracheostomy mask |
1,780 |
1,733 |
$5K |
| E0260 |
Hosp bed semi-electr w/ matt |
36 |
36 |
$4K |
| A7007 |
Lg vol nebulizer disposable |
891 |
865 |
$4K |
| A7012 |
Nebulizer water collec devic |
1,014 |
965 |
$4K |
| T4525 |
Adult size pull-on sm |
50 |
50 |
$4K |
| A7010 |
Disposable corrugated tubing |
310 |
289 |
$3K |
| E0562 |
Humidifier heated used w pap |
279 |
269 |
$3K |
| E0570 |
Nebulizer with compression |
134 |
127 |
$3K |
| A7037 |
Pos airway pressure tubing |
147 |
141 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
1,058 |
1,051 |
$1K |
| A4452 |
Waterproof tape |
130 |
130 |
$978.12 |
| A4244 |
Alcohol or peroxide per pint |
1,257 |
1,253 |
$870.51 |
| K0001 |
Standard wheelchair |
26 |
26 |
$683.49 |
| E0600 |
Suction pump portab hom modl |
49 |
48 |
$681.68 |
| A7038 |
Pos airway pressure filter |
206 |
189 |
$630.16 |
| A7035 |
Pos airway press headgear |
28 |
26 |
$272.71 |
| A7013 |
Disposable compressor filter |
28 |
25 |
$13.30 |