| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
4,541 |
4,123 |
$1.29M |
| E1399 |
Durable medical equipment mi |
2,033 |
408 |
$1.10M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,230 |
1,145 |
$1.08M |
| B9998 |
Enteral supp not otherwise c |
7,978 |
4,581 |
$932K |
| B4153 |
Ef hydrolyzed/amino acids |
582 |
536 |
$907K |
| T1999 |
Noc retail items andsupplies |
6,180 |
2,778 |
$626K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,460 |
1,374 |
$505K |
| B4149 |
Ef blenderized foods |
985 |
866 |
$377K |
| B4150 |
Ef complet w/intact nutrient |
1,234 |
1,052 |
$345K |
| A4554 |
Disposable underpads |
6,788 |
6,270 |
$228K |
| T4522 |
Adult size brief/diaper med |
1,764 |
1,613 |
$181K |
| A4606 |
Oxygen probe used w oximeter |
2,004 |
1,397 |
$161K |
| T4523 |
Adult size brief/diaper lg |
1,311 |
1,212 |
$148K |
| E1390 |
Oxygen concentrator |
1,244 |
1,151 |
$141K |
| B4155 |
Ef incomplete/modular |
369 |
348 |
$134K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
754 |
654 |
$129K |
| B4034 |
Enter feed supkit syr by day |
823 |
723 |
$95K |
| T4521 |
Adult size brief/diaper sm |
669 |
629 |
$67K |
| T4534 |
Youth size pull-on |
652 |
602 |
$67K |
| T4530 |
Ped size brief/diaper lg |
638 |
599 |
$65K |
| A7000 |
Disposable canister for pump |
2,561 |
2,334 |
$64K |
| A4322 |
Irrigation syringe |
5,659 |
4,420 |
$57K |
| E0482 |
Cough stimulating device |
197 |
182 |
$51K |
| A4335 |
Incontinence supply |
8,156 |
7,602 |
$50K |
| K0108 |
W/c component-accessory nos |
159 |
26 |
$48K |
| A6402 |
Sterile gauze <= 16 sq in |
3,717 |
3,387 |
$46K |
| A7002 |
Tubing used w suction pump |
2,601 |
2,359 |
$44K |
| B4152 |
Ef calorie dense>/=1.5kcal |
81 |
74 |
$33K |
| A9900 |
Supply/accessory/service |
1,142 |
828 |
$32K |
| A4927 |
Non-sterile gloves |
4,520 |
4,170 |
$30K |
| A4351 |
Straight tip urine catheter |
127 |
122 |
$27K |
| E0431 |
Portable gaseous 02 |
1,218 |
1,038 |
$25K |
| A4657 |
Syringe w/wo needle |
3,150 |
3,004 |
$23K |
| T4535 |
Disposable liner/shield/pad |
957 |
864 |
$22K |
| A4628 |
Oropharyngeal suction cath |
2,953 |
2,669 |
$22K |
| E0277 |
Powered pres-redu air mattrs |
95 |
82 |
$19K |
| A4624 |
Tracheal suction tube |
152 |
142 |
$19K |
| A4452 |
Waterproof tape |
1,757 |
1,609 |
$16K |
| T4527 |
Adult size pull-on lg |
87 |
74 |
$12K |
| B4104 |
Additive for enteral formula |
68 |
65 |
$11K |
| K0739 |
Repair/svc dme non-oxygen eq |
120 |
103 |
$10K |
| A7003 |
Nebulizer administration set |
2,611 |
2,448 |
$9K |
| A6250 |
Skin seal protect moisturizr |
1,139 |
1,014 |
$7K |
| B9002 |
Enter nutr inf pump any type |
24 |
24 |
$7K |
| E0600 |
Suction pump portab hom modl |
62 |
59 |
$6K |
| A4213 |
20+ cc syringe only |
1,697 |
1,507 |
$5K |
| A7015 |
Aerosol mask used w nebulize |
2,395 |
2,235 |
$3K |
| T4526 |
Adult size pull-on med |
24 |
24 |
$3K |
| A4216 |
Sterile water/saline, 10 ml |
181 |
167 |
$3K |
| E0562 |
Humidifier heated used w pap |
114 |
107 |
$2K |
| A4450 |
Non-waterproof tape |
607 |
542 |
$1K |
| B4100 |
Food thickener oral |
25 |
25 |
$1K |
| A4402 |
Lubricant per ounce |
139 |
134 |
$729.49 |