| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J3590 |
Unclassified biologics |
1,177 |
1,078 |
$3.85M |
| J3490 |
Drugs unclassified injection |
8,292 |
1,949 |
$3.11M |
| S9342 |
Hit enteral pump diem |
8,373 |
7,042 |
$2.61M |
| B4161 |
Ef ped hydrolyzed/amino acid |
2,795 |
2,269 |
$1.67M |
| J0585 |
Injection,onabotulinumtoxina |
1,333 |
1,292 |
$1.57M |
| 99601 |
|
9,938 |
3,991 |
$1.20M |
| S9500 |
Hit antibiotic q24h diem |
2,366 |
642 |
$750K |
| B4149 |
Ef blenderized foods |
1,451 |
1,248 |
$577K |
| S9341 |
Hit enteral grav diem |
1,689 |
1,485 |
$522K |
| T4527 |
Adult size pull-on lg |
5,196 |
4,811 |
$517K |
| B9998 |
Enteral supp not otherwise c |
3,112 |
2,200 |
$512K |
| T4526 |
Adult size pull-on med |
4,996 |
4,669 |
$446K |
| B4150 |
Ef complet w/intact nutrient |
7,192 |
4,609 |
$409K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,991 |
1,651 |
$334K |
| B4035 |
Enteral feed supp pump per d |
2,398 |
1,616 |
$294K |
| S9379 |
Hit noc per diem |
3,514 |
982 |
$261K |
| S9494 |
Hit antibiotic total diem |
502 |
139 |
$240K |
| T4541 |
Large disposable underpad |
14,474 |
13,261 |
$226K |
| T4528 |
Adult size pull-on xl |
2,398 |
2,205 |
$226K |
| B4154 |
Ef spec metabolic noninherit |
1,727 |
1,265 |
$209K |
| T4522 |
Adult size brief/diaper med |
2,023 |
1,847 |
$180K |
| S9343 |
Hit enteral bolus nurs |
663 |
570 |
$170K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,331 |
1,256 |
$161K |
| T4523 |
Adult size brief/diaper lg |
1,885 |
1,702 |
$161K |
| B4081 |
Enteral ng tubing w/ stylet |
2,871 |
2,423 |
$159K |
| A4927 |
Non-sterile gloves |
12,518 |
11,241 |
$146K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,506 |
1,005 |
$128K |
| B4036 |
Enteral feed sup kit grav by |
5,566 |
3,311 |
$127K |
| T4534 |
Youth size pull-on |
1,413 |
1,203 |
$121K |
| T4535 |
Disposable liner/shield/pad |
2,480 |
2,289 |
$118K |
| J7300 |
Intra copp contra (paragard) |
116 |
116 |
$96K |
| T4525 |
Adult size pull-on sm |
1,027 |
953 |
$95K |
| J7307 |
Etonogestrel implant system |
81 |
81 |
$89K |
| T4524 |
Adult size brief/diaper xl |
939 |
835 |
$85K |
| 99602 |
Nursing care in home rn |
780 |
459 |
$66K |
| A9270 |
Non-covered item or service |
3,919 |
3,568 |
$59K |
| B4155 |
Ef incomplete/modular |
1,111 |
882 |
$49K |
| J1729 |
Inj hydroxyprogst capoat nos |
15 |
12 |
$37K |
| T4521 |
Adult size brief/diaper sm |
395 |
341 |
$35K |
| A9901 |
Delivery/set up/dispensing |
413 |
366 |
$34K |
| T4530 |
Ped size brief/diaper lg |
178 |
149 |
$17K |
| A9276 |
Disposable sensor, cgm sys |
27 |
27 |
$11K |
| A9274 |
Ext amb insulin delivery sys |
14 |
14 |
$10K |
| B4034 |
Enter feed supkit syr by day |
165 |
120 |
$7K |
| B9002 |
Enter nutr inf pump any type |
103 |
100 |
$7K |
| A4335 |
Incontinence supply |
3,322 |
2,842 |
$4K |
| A4649 |
Surgical supplies |
301 |
45 |
$2K |
| T4532 |
Ped size pull-on lg |
12 |
12 |
$1K |
| J1642 |
Inj heparin sodium per 10 u |
34 |
12 |
$1K |
| E1399 |
Durable medical equipment mi |
38 |
27 |
$1K |
| A4520 |
Incontinence garment anytype |
80 |
71 |
$930.62 |
| S9562 |
Ht inj palivizumab/ab diem |
70 |
64 |
$914.00 |
| A4216 |
Sterile water/saline, 10 ml |
68 |
25 |
$749.18 |
| A6216 |
Non-sterile gauze<=16 sq in |
52 |
47 |
$580.80 |
| A4554 |
Disposable underpads |
118 |
101 |
$579.00 |
| E0776 |
Iv pole |
275 |
223 |
$453.42 |
| A4213 |
20+ cc syringe only |
17 |
14 |
$169.60 |
| A4657 |
Syringe w/wo needle |
54 |
44 |
$165.85 |
| A6457 |
Tubular dressing |
21 |
14 |
$34.46 |
| S9999 |
Sales tax |
770 |
541 |
$14.71 |