| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
2,526 |
2,457 |
$2.31M |
| B4035 |
Enteral feed supp pump per d |
4,079 |
4,025 |
$1.23M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,777 |
3,660 |
$1.06M |
| E0465 |
Home vent invasive interface |
1,128 |
1,119 |
$1.00M |
| B4153 |
Ef hydrolyzed/amino acids |
502 |
460 |
$695K |
| B9998 |
Enteral supp not otherwise c |
5,988 |
5,046 |
$577K |
| B4149 |
Ef blenderized foods |
952 |
941 |
$463K |
| A4554 |
Disposable underpads |
12,218 |
11,998 |
$350K |
| T4532 |
Ped size pull-on lg |
2,684 |
2,627 |
$337K |
| E1390 |
Oxygen concentrator |
2,450 |
2,420 |
$300K |
| A4606 |
Oxygen probe used w oximeter |
2,485 |
2,262 |
$270K |
| B4150 |
Ef complet w/intact nutrient |
868 |
847 |
$255K |
| A4624 |
Tracheal suction tube |
1,176 |
1,148 |
$204K |
| T4530 |
Ped size brief/diaper lg |
2,238 |
2,214 |
$201K |
| T4522 |
Adult size brief/diaper med |
1,704 |
1,683 |
$180K |
| A4629 |
Tracheostomy care kit |
1,348 |
1,314 |
$147K |
| A4353 |
Intermittent urinary cath |
213 |
197 |
$137K |
| T4521 |
Adult size brief/diaper sm |
1,053 |
1,038 |
$106K |
| A7000 |
Disposable canister for pump |
3,151 |
3,128 |
$105K |
| A4322 |
Irrigation syringe |
4,522 |
4,435 |
$100K |
| T4526 |
Adult size pull-on med |
856 |
846 |
$75K |
| T4523 |
Adult size brief/diaper lg |
683 |
677 |
$74K |
| A4335 |
Incontinence supply |
13,982 |
13,622 |
$71K |
| E0431 |
Portable gaseous 02 |
3,048 |
3,018 |
$67K |
| A7520 |
Trach/laryn tube non-cuffed |
1,312 |
1,286 |
$61K |
| A7526 |
Tracheostomy tube collar |
1,668 |
1,503 |
$61K |
| A7002 |
Tubing used w suction pump |
3,177 |
3,112 |
$61K |
| T4524 |
Adult size brief/diaper xl |
316 |
308 |
$42K |
| T4535 |
Disposable liner/shield/pad |
1,689 |
1,660 |
$42K |
| T1999 |
Noc retail items andsupplies |
5,994 |
4,128 |
$39K |
| T4531 |
Ped size pull-on sm/med |
316 |
312 |
$36K |
| B4152 |
Ef calorie dense>/=1.5kcal |
97 |
96 |
$32K |
| T4527 |
Adult size pull-on lg |
261 |
255 |
$29K |
| A4927 |
Non-sterile gloves |
3,553 |
3,509 |
$26K |
| A4605 |
Trach suction cath close sys |
118 |
101 |
$25K |
| A6216 |
Non-sterile gauze<=16 sq in |
4,401 |
4,270 |
$23K |
| A4628 |
Oropharyngeal suction cath |
3,162 |
3,118 |
$20K |
| A7003 |
Nebulizer administration set |
3,545 |
3,489 |
$13K |
| A4216 |
Sterile water/saline, 10 ml |
469 |
411 |
$11K |
| A4402 |
Lubricant per ounce |
1,901 |
1,887 |
$10K |
| A4450 |
Non-waterproof tape |
3,939 |
3,894 |
$7K |
| A4213 |
20+ cc syringe only |
1,961 |
1,941 |
$6K |
| T4525 |
Adult size pull-on sm |
63 |
63 |
$6K |
| A7525 |
Tracheostomy mask |
1,017 |
1,008 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
294 |
288 |
$3K |
| A9900 |
Supply/accessory/service |
582 |
576 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
1,314 |
1,298 |
$2K |
| A4244 |
Alcohol or peroxide per pint |
647 |
645 |
$465.37 |
| A4481 |
Tracheostoma filter |
12 |
12 |
$168.25 |