| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4152 |
Ef calorie dense>/=1.5kcal |
10,108 |
5,551 |
$304K |
| B4154 |
Ef spec metabolic noninherit |
6,157 |
3,309 |
$302K |
| B4035 |
Enteral feed supp pump per d |
12,467 |
6,914 |
$238K |
| B4034 |
Enter feed supkit syr by day |
5,467 |
3,094 |
$89K |
| A4554 |
Disposable underpads |
1,137 |
987 |
$44K |
| A4314 |
Cath w/drainage 2-way latex |
9,533 |
5,903 |
$42K |
| B4150 |
Ef complet w/intact nutrient |
759 |
449 |
$36K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
2,555 |
1,500 |
$32K |
| A5063 |
Drain ostomy pouch w/flange |
2,163 |
1,289 |
$28K |
| T4535 |
Disposable liner/shield/pad |
504 |
425 |
$27K |
| B9002 |
Enter nutr inf pump any type |
2,578 |
1,648 |
$27K |
| K0003 |
Lightweight wheelchair |
5,687 |
3,334 |
$25K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,294 |
878 |
$22K |
| T4527 |
Adult size pull-on lg |
343 |
237 |
$21K |
| A4357 |
Bedside drainage bag |
10,077 |
6,232 |
$15K |
| E0261 |
Hosp bed semi-electr w/o mat |
1,810 |
1,140 |
$14K |
| A4425 |
Ost pch drain for barrier fl |
1,069 |
627 |
$11K |
| K0001 |
Standard wheelchair |
2,243 |
1,555 |
$11K |
| K0823 |
Pwc gp 2 std cap chair |
217 |
194 |
$8K |
| E1390 |
Oxygen concentrator |
629 |
353 |
$7K |
| E0973 |
W/ch access det adj armrest |
993 |
256 |
$6K |
| T4526 |
Adult size pull-on med |
72 |
64 |
$6K |
| E0630 |
Patient lift hydraulic |
531 |
322 |
$5K |
| K0002 |
Stnd hemi (low seat) whlchr |
658 |
431 |
$4K |
| K0195 |
Elevating whlchair leg rests |
731 |
374 |
$2K |
| A4409 |
Ost skn barr convex <=4 sq i |
68 |
49 |
$1K |
| E2601 |
Gen w/c cushion wdth < 22 in |
357 |
160 |
$923.68 |
| E2611 |
Gen use back cush wdth <22in |
69 |
28 |
$560.04 |
| E0143 |
Walker folding wheeled w/o s |
14 |
12 |
$409.07 |
| A4253 |
Blood glucose/reagent strips |
82 |
44 |
$396.15 |
| E0570 |
Nebulizer with compression |
109 |
49 |
$343.40 |
| E0163 |
Commode chair with fixed arm |
30 |
24 |
$314.67 |
| A5061 |
Pouch drainable w barrier at |
24 |
12 |
$173.52 |
| E0607 |
Blood glucose monitor home |
23 |
12 |
$88.85 |
| A4259 |
Lancets per box |
77 |
44 |
$88.53 |