| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
8,521 |
8,051 |
$835K |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,500 |
1,413 |
$801K |
| E1390 |
Oxygen concentrator |
16,126 |
15,982 |
$599K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,933 |
1,768 |
$340K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,187 |
3,052 |
$278K |
| B4150 |
Ef complet w/intact nutrient |
4,426 |
4,222 |
$270K |
| B4153 |
Ef hydrolyzed/amino acids |
623 |
588 |
$217K |
| B4149 |
Ef blenderized foods |
362 |
339 |
$129K |
| A7030 |
Cpap full face mask |
2,256 |
2,252 |
$120K |
| B4034 |
Enter feed supkit syr by day |
1,837 |
1,740 |
$101K |
| A7031 |
Replacement facemask interfa |
3,063 |
3,050 |
$79K |
| B9002 |
Enter nutr inf pump any type |
1,639 |
1,626 |
$79K |
| E0431 |
Portable gaseous 02 |
10,493 |
10,414 |
$77K |
| B4088 |
Gastro/jejuno tube, low-pro |
781 |
761 |
$55K |
| E0570 |
Nebulizer with compression |
8,354 |
8,311 |
$52K |
| B4155 |
Ef incomplete/modular |
713 |
687 |
$44K |
| A7034 |
Nasal application device |
1,091 |
1,089 |
$39K |
| A7032 |
Replacement nasal cushion |
788 |
787 |
$25K |
| E0601 |
Cont airway pressure device |
1,135 |
1,131 |
$23K |
| A7035 |
Pos airway press headgear |
1,944 |
1,940 |
$22K |
| A4604 |
Tubing with heating element |
811 |
809 |
$21K |
| A7037 |
Pos airway pressure tubing |
2,462 |
2,457 |
$20K |
| A7038 |
Pos airway pressure filter |
4,932 |
4,901 |
$16K |
| B4154 |
Ef spec metabolic noninherit |
105 |
101 |
$16K |
| A7033 |
Replacement nasal pillows |
409 |
408 |
$11K |
| E0562 |
Humidifier heated used w pap |
901 |
895 |
$11K |
| A7046 |
Repl water chamber, pap dev |
1,693 |
1,688 |
$11K |
| E0776 |
Iv pole |
3,356 |
3,353 |
$10K |
| E1392 |
Portable oxygen concentrator |
615 |
614 |
$8K |
| K0738 |
Portable gas oxygen system |
323 |
320 |
$5K |
| A7005 |
Nondisposable nebulizer set |
622 |
617 |
$4K |
| K0001 |
Standard wheelchair |
361 |
361 |
$4K |
| E0443 |
Portable 02 contents, gas |
163 |
159 |
$3K |
| A7003 |
Nebulizer administration set |
1,824 |
1,741 |
$2K |
| K0195 |
Elevating whlchair leg rests |
176 |
173 |
$753.93 |
| A7039 |
Filter, non disposable w pap |
149 |
148 |
$488.57 |
| E0442 |
Stationary o2 contents, liq |
12 |
12 |
$432.61 |
| B9998 |
Enteral supp not otherwise c |
14 |
12 |
$282.24 |
| A7013 |
Disposable compressor filter |
84 |
83 |
$28.86 |
| A7015 |
Aerosol mask used w nebulize |
25 |
24 |
$16.47 |