| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
435 |
360 |
$90K |
| B4161 |
Ef ped hydrolyzed/amino acid |
80 |
75 |
$46K |
| B4035 |
Enteral feed supp pump per d |
103 |
99 |
$35K |
| B9998 |
Enteral supp not otherwise c |
258 |
113 |
$33K |
| E0601 |
Cont airway pressure device |
497 |
496 |
$29K |
| E1390 |
Oxygen concentrator |
101 |
97 |
$15K |
| K0001 |
Standard wheelchair |
322 |
303 |
$11K |
| T4532 |
Ped size pull-on lg |
38 |
28 |
$5K |
| A4554 |
Disposable underpads |
118 |
101 |
$3K |
| A4335 |
Incontinence supply |
512 |
488 |
$3K |
| E0431 |
Portable gaseous 02 |
88 |
84 |
$2K |
| E0990 |
Wheelchair elevating leg res |
229 |
150 |
$2K |
| T1999 |
Noc retail items andsupplies |
288 |
123 |
$1K |
| K0195 |
Elevating whlchair leg rests |
58 |
53 |
$674.18 |
| A4322 |
Irrigation syringe |
29 |
27 |
$228.38 |
| E0776 |
Iv pole |
25 |
25 |
$192.25 |
| A7003 |
Nebulizer administration set |
38 |
38 |
$163.58 |
| A7015 |
Aerosol mask used w nebulize |
12 |
12 |
$18.70 |
| A7013 |
Disposable compressor filter |
24 |
24 |
$15.25 |