| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
21,125 |
15,324 |
$8.41M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
34,294 |
28,479 |
$5.63M |
| B4035 |
Enteral feed supp pump per d |
27,195 |
22,249 |
$3.13M |
| B9998 |
Enteral supp not otherwise c |
52,681 |
25,544 |
$2.61M |
| B4149 |
Ef blenderized foods |
6,678 |
5,396 |
$1.42M |
| E0465 |
Home vent invasive interface |
2,721 |
1,691 |
$1.18M |
| E0570 |
Nebulizer with compression |
12,360 |
11,252 |
$787K |
| S8189 |
Trach supply noc |
7,456 |
3,349 |
$781K |
| B4158 |
Ef ped complete intact nut |
4,910 |
4,027 |
$751K |
| E1390 |
Oxygen concentrator |
16,284 |
13,094 |
$721K |
| A4606 |
Oxygen probe used w oximeter |
8,610 |
6,644 |
$638K |
| E0445 |
Oximeter non-invasive |
6,222 |
4,981 |
$497K |
| B9002 |
Enter nutr inf pump any type |
12,137 |
9,623 |
$488K |
| B4102 |
Ef adult fluids and electro |
2,286 |
1,840 |
$487K |
| A4217 |
Sterile water/saline, 500 ml |
7,190 |
5,237 |
$425K |
| A4624 |
Tracheal suction tube |
3,557 |
2,782 |
$408K |
| A6197 |
Alginate drsg >16 <=48 sq in |
6,313 |
5,194 |
$385K |
| E1399 |
Durable medical equipment mi |
29,869 |
10,657 |
$380K |
| A7526 |
Tracheostomy tube collar |
5,106 |
3,958 |
$320K |
| B4150 |
Ef complet w/intact nutrient |
3,180 |
2,684 |
$306K |
| A4483 |
Moisture exchanger |
2,442 |
1,838 |
$286K |
| A4605 |
Trach suction cath close sys |
1,252 |
1,036 |
$283K |
| A4452 |
Waterproof tape |
18,409 |
14,424 |
$275K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,608 |
2,179 |
$270K |
| E0619 |
Apnea monitor w recorder |
2,249 |
1,875 |
$269K |
| A7507 |
Integrated filter & holder |
2,389 |
1,922 |
$259K |
| A7520 |
Trach/laryn tube non-cuffed |
2,713 |
1,863 |
$241K |
| B4103 |
Ef ped fluid and electrolyte |
2,348 |
1,933 |
$236K |
| E0482 |
Cough stimulating device |
1,115 |
956 |
$227K |
| B4153 |
Ef hydrolyzed/amino acids |
680 |
585 |
$214K |
| A6402 |
Sterile gauze <= 16 sq in |
19,367 |
15,876 |
$202K |
| E0431 |
Portable gaseous 02 |
15,808 |
13,122 |
$163K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
4,718 |
3,887 |
$158K |
| E0603 |
Electric breast pump |
1,223 |
1,120 |
$154K |
| B4155 |
Ef incomplete/modular |
4,034 |
3,279 |
$133K |
| E0443 |
Portable 02 contents, gas |
4,147 |
3,221 |
$131K |
| A6260 |
Wound cleanser any type/size |
5,353 |
4,683 |
$125K |
| B4100 |
Food thickener oral |
2,299 |
1,911 |
$113K |
| A7000 |
Disposable canister for pump |
8,323 |
6,722 |
$108K |
| E0600 |
Suction pump portab hom modl |
4,574 |
3,551 |
$108K |
| A4927 |
Non-sterile gloves |
8,800 |
6,883 |
$107K |
| A7005 |
Nondisposable nebulizer set |
10,213 |
9,227 |
$105K |
| E0202 |
Phototherapy light w/ photom |
1,145 |
513 |
$104K |
| E1150 |
Wheelchair standard w/ leg r |
2,056 |
1,859 |
$103K |
| B4082 |
Enteral ng tubing w/o stylet |
2,769 |
2,204 |
$102K |
| B4154 |
Ef spec metabolic noninherit |
565 |
492 |
$97K |
| A4625 |
Trach care kit for new trach |
990 |
777 |
$97K |
| A7002 |
Tubing used w suction pump |
8,515 |
6,426 |
$96K |
| B4088 |
Gastro/jejuno tube, low-pro |
4,929 |
4,186 |
$92K |
| B4034 |
Enter feed supkit syr by day |
2,291 |
1,831 |
$90K |
| A4627 |
Spacer bag/reservoir |
5,782 |
5,032 |
$86K |
| E0776 |
Iv pole |
11,325 |
9,518 |
$82K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
468 |
415 |
$75K |
| A4618 |
Breathing circuits |
3,656 |
2,429 |
$75K |
| A4628 |
Oropharyngeal suction cath |
5,943 |
4,601 |
$70K |
| E1405 |
O2/water vapor enrich w/heat |
2,168 |
1,821 |
$69K |
| A4216 |
Sterile water/saline, 10 ml |
3,050 |
2,395 |
$68K |
| A4210 |
Nonneedle injection device |
18,221 |
14,425 |
$66K |
| A4213 |
20+ cc syringe only |
20,271 |
16,868 |
$64K |
| B4036 |
Enteral feed sup kit grav by |
941 |
730 |
$61K |
| E0601 |
Cont airway pressure device |
1,372 |
1,158 |
$54K |
| A6250 |
Skin seal protect moisturizr |
5,212 |
4,460 |
$51K |
| A4402 |
Lubricant per ounce |
8,059 |
6,699 |
$43K |
| E0424 |
Stationary compressed gas 02 |
1,021 |
871 |
$42K |
| A4456 |
Adhesive remover, wipes |
6,732 |
5,712 |
$40K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
1,533 |
1,310 |
$35K |
| A6266 |
Impreg gauze no h20/sal/yard |
3,391 |
2,847 |
$25K |
| A4371 |
Skin barrier powder per oz |
4,008 |
3,484 |
$25K |
| E1392 |
Portable oxygen concentrator |
993 |
786 |
$24K |
| A6258 |
Transparent film >16<=48 in |
1,177 |
1,035 |
$23K |
| A7014 |
Compressor nondispos filter |
9,669 |
8,763 |
$22K |
| E1060 |
Wheelchair detachable arms |
221 |
209 |
$21K |
| A7521 |
Trach/laryn tube cuffed |
200 |
155 |
$20K |
| E0562 |
Humidifier heated used w pap |
2,025 |
1,736 |
$19K |
| A5200 |
Percutaneous catheter anchor |
754 |
645 |
$17K |
| L8501 |
Tracheostomy speaking valve |
177 |
157 |
$16K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
585 |
437 |
$15K |
| A4351 |
Straight tip urine catheter |
87 |
85 |
$15K |
| A4245 |
Alcohol wipes per box |
3,845 |
3,155 |
$13K |
| E0585 |
Nebulizer w/ compressor & he |
903 |
754 |
$12K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,213 |
1,043 |
$11K |
| A7015 |
Aerosol mask used w nebulize |
11,081 |
9,904 |
$10K |
| B4087 |
Gastro/jejuno tube, std |
429 |
343 |
$10K |
| A7525 |
Tracheostomy mask |
2,153 |
1,639 |
$9K |
| A7046 |
Repl water chamber, pap dev |
643 |
497 |
$8K |
| A7004 |
Disposable nebulizer sml vol |
3,105 |
2,341 |
$7K |
| A7006 |
Filtered nebulizer admin set |
1,561 |
1,493 |
$7K |
| A7034 |
Nasal application device |
205 |
186 |
$6K |
| A6196 |
Alginate dressing <=16 sq in |
43 |
36 |
$6K |
| A4450 |
Non-waterproof tape |
3,238 |
2,625 |
$5K |
| A4649 |
Surgical supplies |
1,432 |
906 |
$4K |
| E0990 |
Wheelchair elevating leg res |
1,274 |
1,049 |
$4K |
| E0974 |
W/ch access anti-rollback |
1,039 |
910 |
$3K |
| A7018 |
Water distilled w/nebulizer |
947 |
717 |
$3K |
| E0471 |
Rad w/backup non inv intrfc |
29 |
25 |
$3K |
| A4556 |
Electrodes, pair |
65 |
47 |
$3K |
| A4333 |
Urinary cath anchor device |
296 |
268 |
$3K |
| A4244 |
Alcohol or peroxide per pint |
2,024 |
1,610 |
$3K |
| A6257 |
Transparent film <= 16 sq in |
385 |
282 |
$3K |
| A7020 |
Interface, cough stim device |
222 |
158 |
$3K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
63 |
51 |
$2K |
| T4541 |
Large disposable underpad |
152 |
104 |
$2K |
| A7037 |
Pos airway pressure tubing |
278 |
241 |
$2K |
| A4616 |
Tubing (oxygen) per foot |
1,738 |
1,182 |
$2K |
| A4322 |
Irrigation syringe |
119 |
101 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
1,306 |
1,133 |
$1K |
| A7038 |
Pos airway pressure filter |
975 |
799 |
$1K |
| A4615 |
Cannula nasal |
1,756 |
1,267 |
$1K |
| A7003 |
Nebulizer administration set |
506 |
412 |
$1K |
| A7039 |
Filter, non disposable w pap |
460 |
399 |
$1K |
| A7008 |
Disposable nebulizer prefill |
60 |
45 |
$1K |
| A7035 |
Pos airway press headgear |
58 |
53 |
$442.39 |
| A4557 |
Lead wires, pair |
17 |
13 |
$208.41 |
| E1355 |
Oxygen supplies stand/rack |
48 |
41 |
$86.18 |
| A9270 |
Non-covered item or service |
664 |
437 |
$43.70 |
| A7013 |
Disposable compressor filter |
31 |
29 |
$13.41 |