| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
9,327 |
7,225 |
$5.80M |
| B9998 |
Enteral supp not otherwise c |
25,776 |
15,793 |
$4.32M |
| B4035 |
Enteral feed supp pump per d |
13,509 |
12,754 |
$3.66M |
| E0466 |
Home vent non-invasive inter |
2,620 |
2,563 |
$2.03M |
| E0465 |
Home vent invasive interface |
2,512 |
2,478 |
$1.94M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,372 |
6,006 |
$1.73M |
| B4153 |
Ef hydrolyzed/amino acids |
996 |
876 |
$1.46M |
| B4149 |
Ef blenderized foods |
3,336 |
2,934 |
$1.14M |
| E1390 |
Oxygen concentrator |
9,607 |
9,470 |
$1.10M |
| B4155 |
Ef incomplete/modular |
3,082 |
2,831 |
$1.04M |
| E1399 |
Durable medical equipment mi |
2,058 |
2,018 |
$1.00M |
| E0482 |
Cough stimulating device |
2,884 |
2,854 |
$759K |
| A4606 |
Oxygen probe used w oximeter |
6,312 |
5,581 |
$650K |
| E0445 |
Oximeter non-invasive |
3,114 |
3,019 |
$567K |
| B9002 |
Enter nutr inf pump any type |
3,777 |
3,713 |
$443K |
| A4554 |
Disposable underpads |
13,542 |
12,608 |
$415K |
| T4534 |
Youth size pull-on |
3,397 |
3,180 |
$393K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,185 |
1,838 |
$377K |
| A4624 |
Tracheal suction tube |
2,001 |
1,817 |
$315K |
| B4150 |
Ef complet w/intact nutrient |
1,117 |
1,037 |
$301K |
| T4530 |
Ped size brief/diaper lg |
2,866 |
2,716 |
$279K |
| B4104 |
Additive for enteral formula |
2,171 |
1,964 |
$265K |
| A7000 |
Disposable canister for pump |
7,364 |
7,088 |
$246K |
| B4152 |
Ef calorie dense>/=1.5kcal |
715 |
673 |
$231K |
| T4522 |
Adult size brief/diaper med |
2,083 |
1,943 |
$222K |
| B4154 |
Ef spec metabolic noninherit |
317 |
288 |
$216K |
| A4629 |
Tracheostomy care kit |
2,074 |
1,948 |
$198K |
| E0431 |
Portable gaseous 02 |
8,931 |
8,792 |
$180K |
| A4605 |
Trach suction cath close sys |
1,115 |
993 |
$173K |
| B4103 |
Ef ped fluid and electrolyte |
1,243 |
1,181 |
$164K |
| B4034 |
Enter feed supkit syr by day |
1,261 |
1,165 |
$162K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
1,801 |
1,721 |
$160K |
| A4322 |
Irrigation syringe |
13,244 |
12,525 |
$159K |
| A4353 |
Intermittent urinary cath |
249 |
189 |
$157K |
| T1999 |
Noc retail items andsupplies |
24,321 |
14,114 |
$155K |
| A9900 |
Supply/accessory/service |
2,991 |
1,880 |
$145K |
| T4521 |
Adult size brief/diaper sm |
1,439 |
1,302 |
$142K |
| A7520 |
Trach/laryn tube non-cuffed |
2,010 |
1,824 |
$134K |
| E0570 |
Nebulizer with compression |
1,242 |
1,226 |
$130K |
| A7002 |
Tubing used w suction pump |
7,211 |
6,946 |
$126K |
| T4532 |
Ped size pull-on lg |
849 |
803 |
$125K |
| A4216 |
Sterile water/saline, 10 ml |
3,804 |
3,428 |
$118K |
| T4523 |
Adult size brief/diaper lg |
1,052 |
956 |
$115K |
| B4158 |
Ef ped complete intact nut |
560 |
480 |
$106K |
| E0471 |
Rad w/backup non inv intrfc |
302 |
298 |
$105K |
| A4335 |
Incontinence supply |
16,159 |
15,502 |
$86K |
| A7526 |
Tracheostomy tube collar |
2,629 |
2,418 |
$84K |
| A6457 |
Tubular dressing |
3,409 |
3,225 |
$81K |
| T4526 |
Adult size pull-on med |
672 |
629 |
$78K |
| A5200 |
Percutaneous catheter anchor |
2,276 |
1,854 |
$74K |
| B4100 |
Food thickener oral |
3,197 |
3,077 |
$72K |
| A6257 |
Transparent film <= 16 sq in |
1,705 |
1,628 |
$51K |
| E0601 |
Cont airway pressure device |
477 |
473 |
$46K |
| A4628 |
Oropharyngeal suction cath |
6,695 |
6,374 |
$40K |
| A6216 |
Non-sterile gauze<=16 sq in |
7,958 |
7,523 |
$36K |
| B4036 |
Enteral feed sup kit grav by |
430 |
407 |
$35K |
| T4529 |
Ped size brief/diaper sm/med |
597 |
560 |
$34K |
| A7521 |
Trach/laryn tube cuffed |
605 |
550 |
$33K |
| T4525 |
Adult size pull-on sm |
317 |
297 |
$33K |
| E0776 |
Iv pole |
3,552 |
3,506 |
$33K |
| A6250 |
Skin seal protect moisturizr |
3,514 |
3,331 |
$33K |
| A4402 |
Lubricant per ounce |
5,989 |
5,656 |
$29K |
| A7003 |
Nebulizer administration set |
8,320 |
8,066 |
$28K |
| A7030 |
Cpap full face mask |
293 |
284 |
$28K |
| E0562 |
Humidifier heated used w pap |
1,116 |
1,093 |
$24K |
| A4927 |
Non-sterile gloves |
2,841 |
2,715 |
$20K |
| A6212 |
Foam drg <=16 sq in w/border |
89 |
79 |
$19K |
| A4452 |
Waterproof tape |
2,576 |
2,445 |
$17K |
| A6402 |
Sterile gauze <= 16 sq in |
1,662 |
1,485 |
$16K |
| A4450 |
Non-waterproof tape |
7,438 |
7,227 |
$11K |
| A7037 |
Pos airway pressure tubing |
544 |
529 |
$10K |
| A4217 |
Sterile water/saline, 500 ml |
495 |
477 |
$8K |
| T4535 |
Disposable liner/shield/pad |
157 |
145 |
$5K |
| T4527 |
Adult size pull-on lg |
37 |
36 |
$5K |
| A7038 |
Pos airway pressure filter |
995 |
941 |
$4K |
| A7525 |
Tracheostomy mask |
1,090 |
1,030 |
$4K |
| A4385 |
Ost skn barrier sld ext wear |
28 |
27 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
398 |
356 |
$4K |
| A7015 |
Aerosol mask used w nebulize |
3,095 |
2,929 |
$4K |
| A4670 |
Automatic bp monitor, dial |
72 |
72 |
$4K |
| E0600 |
Suction pump portab hom modl |
12 |
12 |
$3K |
| B4082 |
Enteral ng tubing w/o stylet |
55 |
51 |
$3K |
| S8101 |
Spacer with mask |
121 |
115 |
$3K |
| E0565 |
Compressor air power source |
81 |
81 |
$3K |
| A4371 |
Skin barrier powder per oz |
498 |
454 |
$2K |
| A4627 |
Spacer bag/reservoir |
42 |
42 |
$1K |
| A7046 |
Repl water chamber, pap dev |
69 |
55 |
$767.20 |
| A7010 |
Disposable corrugated tubing |
13 |
12 |
$570.40 |
| A4245 |
Alcohol wipes per box |
123 |
117 |
$521.60 |
| A7005 |
Nondisposable nebulizer set |
27 |
25 |
$498.70 |
| A7013 |
Disposable compressor filter |
652 |
628 |
$418.13 |
| A4244 |
Alcohol or peroxide per pint |
194 |
185 |
$142.65 |
| A4657 |
Syringe w/wo needle |
103 |
93 |
$109.44 |
| A7007 |
Lg vol nebulizer disposable |
13 |
12 |
$84.09 |