| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9342 |
Hit enteral pump diem |
689 |
485 |
$172K |
| B4161 |
Ef ped hydrolyzed/amino acid |
438 |
414 |
$152K |
| E1390 |
Oxygen concentrator |
957 |
946 |
$87K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
642 |
596 |
$52K |
| E0601 |
Cont airway pressure device |
899 |
897 |
$44K |
| S9500 |
Hit antibiotic q24h diem |
193 |
71 |
$44K |
| B4149 |
Ef blenderized foods |
132 |
116 |
$43K |
| E0603 |
Electric breast pump |
175 |
175 |
$37K |
| 99283 |
|
227 |
221 |
$36K |
| B4088 |
Gastro/jejuno tube, low-pro |
264 |
226 |
$35K |
| H0035 |
Mh partial hosp tx under 24h |
118 |
17 |
$34K |
| A7030 |
Cpap full face mask |
328 |
326 |
$33K |
| B4150 |
Ef complet w/intact nutrient |
274 |
252 |
$33K |
| E0465 |
Home vent invasive interface |
65 |
65 |
$28K |
| S9374 |
Hit hydra 1 liter diem |
184 |
43 |
$27K |
| 87491 |
|
430 |
427 |
$26K |
| E0570 |
Nebulizer with compression |
322 |
322 |
$25K |
| E0471 |
Rad w/backup non inv intrfc |
112 |
110 |
$24K |
| B4152 |
Ef calorie dense>/=1.5kcal |
203 |
188 |
$22K |
| S9343 |
Hit enteral bolus nurs |
103 |
80 |
$22K |
| 87631 |
|
196 |
191 |
$22K |
| 99284 |
|
120 |
114 |
$22K |
| 99211 |
|
125 |
111 |
$20K |
| E0470 |
Rad w/o backup non-inv intfc |
176 |
174 |
$18K |
| K0738 |
Portable gas oxygen system |
678 |
675 |
$18K |
| E0562 |
Humidifier heated used w pap |
544 |
541 |
$18K |
| A7034 |
Nasal application device |
242 |
241 |
$16K |
| 82306 |
|
217 |
217 |
$15K |
| 86803 |
|
83 |
83 |
$9K |
| B4153 |
Ef hydrolyzed/amino acids |
28 |
26 |
$9K |
| 87591 |
|
428 |
425 |
$9K |
| B4155 |
Ef incomplete/modular |
88 |
66 |
$9K |
| 96413 |
|
25 |
15 |
$8K |
| 83655 |
|
422 |
418 |
$8K |
| A7035 |
Pos airway press headgear |
401 |
399 |
$8K |
| A7037 |
Pos airway pressure tubing |
361 |
361 |
$8K |
| A4604 |
Tubing with heating element |
208 |
205 |
$8K |
| S9501 |
Hit antibiotic q12h diem |
26 |
12 |
$7K |
| B4158 |
Ef ped complete intact nut |
36 |
32 |
$7K |
| T4530 |
Ped size brief/diaper lg |
64 |
60 |
$7K |
| 86780 |
|
94 |
94 |
$7K |
| T4541 |
Large disposable underpad |
135 |
133 |
$7K |
| 86140 |
|
129 |
123 |
$7K |
| 97110 |
|
69 |
18 |
$7K |
| T4523 |
Adult size brief/diaper lg |
48 |
47 |
$6K |
| A7005 |
Nondisposable nebulizer set |
271 |
270 |
$6K |
| 92507 |
|
46 |
17 |
$6K |
| A4624 |
Tracheal suction tube |
84 |
75 |
$6K |
| B4154 |
Ef spec metabolic noninherit |
92 |
85 |
$5K |
| 99601 |
|
62 |
34 |
$5K |
| A7031 |
Replacement facemask interfa |
179 |
145 |
$5K |
| T4521 |
Adult size brief/diaper sm |
49 |
47 |
$5K |
| 83516 |
|
74 |
73 |
$4K |
| 86003 |
|
60 |
54 |
$4K |
| 87389 |
|
114 |
114 |
$4K |
| 83036 |
|
182 |
180 |
$4K |
| 84443 |
|
373 |
367 |
$4K |
| 99285 |
|
22 |
22 |
$4K |
| T4522 |
Adult size brief/diaper med |
34 |
29 |
$4K |
| A7032 |
Replacement nasal cushion |
83 |
83 |
$4K |
| 83718 |
|
123 |
123 |
$4K |
| 87081 |
|
522 |
508 |
$4K |
| 84439 |
|
247 |
243 |
$4K |
| 85025 |
|
533 |
505 |
$4K |
| B4035 |
Enteral feed supp pump per d |
80 |
76 |
$4K |
| A7520 |
Trach/laryn tube non-cuffed |
78 |
64 |
$3K |
| 83550 |
|
95 |
95 |
$3K |
| G0378 |
Hospital observation per hr |
20 |
17 |
$3K |
| 82728 |
|
131 |
129 |
$3K |
| A7038 |
Pos airway pressure filter |
588 |
576 |
$3K |
| A7046 |
Repl water chamber, pap dev |
262 |
261 |
$3K |
| 87480 |
|
53 |
53 |
$3K |
| 80307 |
|
46 |
42 |
$3K |
| 76770 |
|
12 |
12 |
$3K |
| 80061 |
|
247 |
245 |
$2K |
| A7526 |
Tracheostomy tube collar |
87 |
81 |
$2K |
| A4629 |
Tracheostomy care kit |
55 |
49 |
$2K |
| 87086 |
|
315 |
295 |
$2K |
| K0003 |
Lightweight wheelchair |
33 |
31 |
$2K |
| A7033 |
Replacement nasal pillows |
73 |
73 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
92 |
74 |
$2K |
| 87340 |
|
48 |
48 |
$2K |
| A4628 |
Oropharyngeal suction cath |
209 |
173 |
$2K |
| 82784 |
|
68 |
67 |
$2K |
| 99282 |
|
12 |
12 |
$2K |
| E0431 |
Portable gaseous 02 |
114 |
114 |
$2K |
| 85027 |
|
252 |
240 |
$2K |
| 76705 |
|
19 |
18 |
$2K |
| 86618 |
|
15 |
15 |
$2K |
| 88175 |
|
79 |
79 |
$2K |
| 80053 |
|
208 |
202 |
$2K |
| 83540 |
|
106 |
106 |
$1K |
| 71046 |
|
52 |
51 |
$1K |
| 82465 |
|
122 |
122 |
$1K |
| S9490 |
Hit corticosteroid/diem |
12 |
12 |
$1K |
| 86664 |
|
13 |
13 |
$1K |
| E0600 |
Suction pump portab hom modl |
59 |
58 |
$1K |
| B4034 |
Enter feed supkit syr by day |
48 |
45 |
$1K |
| T4535 |
Disposable liner/shield/pad |
15 |
14 |
$1K |
| A4927 |
Non-sterile gloves |
156 |
113 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
81 |
71 |
$1K |
| 82607 |
|
99 |
99 |
$1K |
| E0445 |
Oximeter non-invasive |
13 |
13 |
$1K |
| 87147 |
|
180 |
180 |
$1K |
| 86317 |
|
16 |
16 |
$1K |
| 82947 |
|
135 |
131 |
$1K |
| 82785 |
|
32 |
31 |
$1K |
| 81001 |
|
282 |
269 |
$1K |
| 80050 |
|
113 |
113 |
$978.10 |
| A7000 |
Disposable canister for pump |
215 |
200 |
$974.91 |
| 80051 |
|
110 |
92 |
$973.66 |
| K0001 |
Standard wheelchair |
25 |
25 |
$953.87 |
| 87624 |
|
48 |
48 |
$855.99 |
| 80048 |
|
109 |
107 |
$855.00 |
| 84450 |
|
124 |
121 |
$844.30 |
| 87510 |
|
53 |
53 |
$832.70 |
| 84460 |
|
137 |
134 |
$732.70 |
| 86665 |
|
13 |
13 |
$717.70 |
| 86850 |
|
12 |
12 |
$699.50 |
| 82565 |
|
157 |
139 |
$662.38 |
| 82570 |
|
82 |
80 |
$647.74 |
| 93005 |
|
48 |
47 |
$636.96 |
| 87186 |
|
97 |
94 |
$635.52 |
| 82746 |
|
23 |
23 |
$626.11 |
| 85652 |
|
141 |
136 |
$617.04 |
| 80076 |
|
72 |
70 |
$601.10 |
| 84520 |
|
121 |
104 |
$566.20 |
| 87660 |
|
53 |
53 |
$558.22 |
| 87088 |
|
119 |
113 |
$531.08 |
| A7002 |
Tubing used w suction pump |
235 |
200 |
$471.05 |
| 85018 |
|
66 |
66 |
$447.76 |
| 87205 |
|
56 |
55 |
$397.45 |
| 87077 |
|
104 |
101 |
$373.68 |
| 84153 |
|
12 |
12 |
$352.12 |
| 84146 |
|
13 |
13 |
$299.82 |
| 87070 |
|
65 |
64 |
$290.60 |
| 82248 |
|
42 |
41 |
$280.57 |
| A7012 |
Nebulizer water collec devic |
50 |
49 |
$277.84 |
| 83721 |
|
17 |
17 |
$261.83 |
| A7015 |
Aerosol mask used w nebulize |
192 |
187 |
$259.73 |
| 84156 |
|
28 |
26 |
$245.98 |
| A7010 |
Disposable corrugated tubing |
12 |
12 |
$238.88 |
| 84403 |
|
15 |
15 |
$222.60 |
| 83735 |
|
30 |
29 |
$218.69 |
| 82040 |
|
15 |
15 |
$216.66 |
| 84702 |
|
15 |
13 |
$213.22 |
| 82043 |
|
53 |
53 |
$189.49 |
| A7003 |
Nebulizer administration set |
106 |
106 |
$170.50 |
| 83690 |
|
12 |
12 |
$163.90 |
| 80069 |
|
15 |
15 |
$130.48 |
| 84100 |
|
12 |
12 |
$112.61 |
| A7036 |
Pos airway press chinstrap |
13 |
13 |
$107.09 |
| 87206 |
|
16 |
16 |
$96.85 |
| 81025 |
|
14 |
13 |
$89.04 |
| 86900 |
|
12 |
12 |
$67.86 |
| A7525 |
Tracheostomy mask |
56 |
54 |
$65.43 |
| J1100 |
Dexamethasone sodium phos |
50 |
50 |
$56.24 |
| J2405 |
Ondansetron hcl injection |
40 |
39 |
$56.24 |
| 85610 |
|
17 |
14 |
$55.90 |
| A7013 |
Disposable compressor filter |
73 |
72 |
$50.58 |
| 85045 |
|
13 |
12 |
$45.64 |
| 86901 |
|
12 |
12 |
$37.06 |
| 82247 |
|
41 |
34 |
$16.14 |
| 96375 |
|
17 |
13 |
$0.00 |
| 36415 |
|
1,336 |
1,264 |
$0.00 |
| 88305 |
|
19 |
18 |
$0.00 |
| 36416 |
|
215 |
209 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
33 |
33 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
17 |
13 |
$0.00 |
| 96374 |
|
20 |
20 |
$0.00 |
| 82962 |
|
18 |
14 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
20 |
20 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
22 |
20 |
$0.00 |
| J1170 |
Hydromorphone injection |
22 |
12 |
$0.00 |
| 84075 |
|
15 |
14 |
$0.00 |