| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7170 |
Inj., emicizumab-kxwh 0.5 mg |
214 |
168 |
$7.29M |
| B4161 |
Ef ped hydrolyzed/amino acid |
10,156 |
4,538 |
$2.28M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
27,644 |
14,487 |
$2.10M |
| B4035 |
Enteral feed supp pump per d |
28,634 |
10,108 |
$1.88M |
| T4534 |
Youth size pull-on |
10,439 |
9,695 |
$897K |
| 90378 |
|
318 |
212 |
$796K |
| B9998 |
Enteral supp not otherwise c |
24,159 |
7,974 |
$737K |
| B4149 |
Ef blenderized foods |
4,378 |
1,782 |
$729K |
| B4152 |
Ef calorie dense>/=1.5kcal |
7,456 |
3,314 |
$510K |
| E0603 |
Electric breast pump |
2,815 |
2,632 |
$494K |
| B4153 |
Ef hydrolyzed/amino acids |
2,813 |
605 |
$439K |
| T4530 |
Ped size brief/diaper lg |
5,434 |
4,900 |
$436K |
| B4034 |
Enter feed supkit syr by day |
12,143 |
4,462 |
$429K |
| B4150 |
Ef complet w/intact nutrient |
6,217 |
3,060 |
$367K |
| B4088 |
Gastro/jejuno tube, low-pro |
3,640 |
3,186 |
$344K |
| T4522 |
Adult size brief/diaper med |
2,552 |
2,338 |
$284K |
| B4155 |
Ef incomplete/modular |
6,917 |
2,934 |
$248K |
| B9002 |
Enter nutr inf pump any type |
3,084 |
2,495 |
$221K |
| J3490 |
Drugs unclassified injection |
3,934 |
137 |
$221K |
| T4541 |
Large disposable underpad |
6,124 |
5,699 |
$197K |
| B4100 |
Food thickener oral |
4,767 |
2,243 |
$172K |
| B4154 |
Ef spec metabolic noninherit |
1,241 |
502 |
$170K |
| T4527 |
Adult size pull-on lg |
1,335 |
1,223 |
$158K |
| B4103 |
Ef ped fluid and electrolyte |
3,079 |
1,782 |
$121K |
| A4352 |
Coude tip urinary catheter |
533 |
480 |
$107K |
| A4351 |
Straight tip urine catheter |
1,062 |
946 |
$103K |
| E0570 |
Nebulizer with compression |
846 |
784 |
$94K |
| T4521 |
Adult size brief/diaper sm |
668 |
631 |
$64K |
| T4523 |
Adult size brief/diaper lg |
469 |
423 |
$60K |
| T4529 |
Ped size brief/diaper sm/med |
569 |
553 |
$46K |
| B4162 |
Ef ped specmetabolic inherit |
326 |
105 |
$42K |
| A7000 |
Disposable canister for pump |
2,237 |
1,987 |
$39K |
| A6212 |
Foam drg <=16 sq in w/border |
654 |
510 |
$37K |
| E0604 |
Hosp grade elec breast pump |
1,260 |
540 |
$30K |
| A4670 |
Automatic bp monitor, dial |
646 |
599 |
$27K |
| A4333 |
Urinary cath anchor device |
3,080 |
2,246 |
$25K |
| A4628 |
Oropharyngeal suction cath |
2,190 |
1,875 |
$17K |
| A4222 |
Infusion supplies with pump |
87 |
39 |
$17K |
| E0135 |
Walker folding adjust/fixed |
379 |
351 |
$16K |
| K0001 |
Standard wheelchair |
341 |
308 |
$15K |
| A4624 |
Tracheal suction tube |
622 |
540 |
$13K |
| E0248 |
Hdtrans bench w/wo comm open |
127 |
125 |
$12K |
| A7003 |
Nebulizer administration set |
2,996 |
2,683 |
$10K |
| J1650 |
Inj enoxaparin sodium |
652 |
169 |
$10K |
| A4344 |
Cath indw foley 2 way silicn |
910 |
663 |
$8K |
| T4531 |
Ped size pull-on sm/med |
120 |
111 |
$8K |
| E0114 |
Crutch underarm pair no wood |
312 |
290 |
$7K |
| B4158 |
Ef ped complete intact nut |
70 |
40 |
$5K |
| A7015 |
Aerosol mask used w nebulize |
3,017 |
2,614 |
$5K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
21 |
14 |
$4K |
| B4082 |
Enteral ng tubing w/o stylet |
171 |
146 |
$4K |
| A4402 |
Lubricant per ounce |
1,458 |
1,342 |
$3K |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
214 |
202 |
$3K |
| B4081 |
Enteral ng tubing w/ stylet |
128 |
101 |
$2K |
| A7005 |
Nondisposable nebulizer set |
118 |
92 |
$2K |
| E0163 |
Commode chair with fixed arm |
25 |
25 |
$1K |
| T4535 |
Disposable liner/shield/pad |
27 |
27 |
$1K |
| A4221 |
Supp non-insulin inf cath/wk |
16 |
12 |
$995.66 |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
14 |
13 |
$564.44 |
| E0155 |
Walker wheel attachment,pair |
44 |
41 |
$555.20 |
| A4398 |
Ostomy irrigation bag |
140 |
107 |
$550.57 |
| J0171 |
Adrenalin epinephrine inject |
78 |
67 |
$494.67 |
| A4450 |
Non-waterproof tape |
336 |
303 |
$342.88 |
| A4369 |
Skin barrier liquid per oz |
107 |
96 |
$262.15 |
| A4358 |
Urinary leg or abdomen bag |
32 |
25 |
$182.36 |
| A6402 |
Sterile gauze <= 16 sq in |
45 |
44 |
$106.72 |
| A5120 |
Skin barrier, wipe or swab |
107 |
89 |
$98.99 |
| A4663 |
Dialysis blood pressure cuff |
12 |
12 |
$0.00 |