| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
4,154 |
3,125 |
$2.18M |
| B4035 |
Enteral feed supp pump per d |
10,195 |
8,099 |
$1.71M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,095 |
5,106 |
$999K |
| E1390 |
Oxygen concentrator |
10,339 |
9,265 |
$546K |
| E0329 |
Ped hospital bed semi/elect |
90 |
65 |
$501K |
| B4162 |
Ef ped specmetabolic inherit |
1,168 |
700 |
$485K |
| E0445 |
Oximeter non-invasive |
4,687 |
4,325 |
$466K |
| B4158 |
Ef ped complete intact nut |
1,283 |
1,041 |
$326K |
| B9002 |
Enter nutr inf pump any type |
4,083 |
3,702 |
$231K |
| E0619 |
Apnea monitor w recorder |
987 |
930 |
$201K |
| T4541 |
Large disposable underpad |
6,099 |
4,738 |
$191K |
| B4034 |
Enter feed supkit syr by day |
2,613 |
1,972 |
$186K |
| B4088 |
Gastro/jejuno tube, low-pro |
2,963 |
2,761 |
$161K |
| T4527 |
Adult size pull-on lg |
2,207 |
1,790 |
$148K |
| A4351 |
Straight tip urine catheter |
1,674 |
1,293 |
$139K |
| T4528 |
Adult size pull-on xl |
1,699 |
1,346 |
$134K |
| T4526 |
Adult size pull-on med |
1,790 |
1,532 |
$129K |
| B4150 |
Ef complet w/intact nutrient |
1,098 |
753 |
$105K |
| A4624 |
Tracheal suction tube |
1,214 |
1,053 |
$103K |
| T4544 |
Adlt disp und/pull on abv xl |
936 |
642 |
$103K |
| B4155 |
Ef incomplete/modular |
1,384 |
1,015 |
$97K |
| E1399 |
Durable medical equipment mi |
99 |
41 |
$95K |
| K0001 |
Standard wheelchair |
6,215 |
4,611 |
$92K |
| E0431 |
Portable gaseous 02 |
7,038 |
6,319 |
$90K |
| B4149 |
Ef blenderized foods |
223 |
158 |
$57K |
| E1236 |
Folding ped wc adjustable |
538 |
435 |
$56K |
| E0600 |
Suction pump portab hom modl |
2,782 |
2,337 |
$52K |
| K0195 |
Elevating whlchair leg rests |
5,856 |
4,531 |
$46K |
| A4606 |
Oxygen probe used w oximeter |
4,032 |
2,683 |
$46K |
| T4523 |
Adult size brief/diaper lg |
592 |
488 |
$42K |
| E0570 |
Nebulizer with compression |
2,755 |
2,389 |
$42K |
| B4152 |
Ef calorie dense>/=1.5kcal |
505 |
385 |
$39K |
| E1392 |
Portable oxygen concentrator |
2,204 |
1,886 |
$39K |
| A4628 |
Oropharyngeal suction cath |
3,596 |
3,371 |
$38K |
| A7000 |
Disposable canister for pump |
4,354 |
4,100 |
$33K |
| T4524 |
Adult size brief/diaper xl |
406 |
380 |
$32K |
| E2611 |
Gen use back cush wdth <22in |
207 |
182 |
$29K |
| E1226 |
Manual fully reclining back |
1,018 |
803 |
$29K |
| E0776 |
Iv pole |
3,220 |
2,986 |
$29K |
| T4522 |
Adult size brief/diaper med |
483 |
426 |
$26K |
| T4535 |
Disposable liner/shield/pad |
1,265 |
816 |
$24K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,516 |
998 |
$21K |
| A7526 |
Tracheostomy tube collar |
405 |
371 |
$20K |
| A7002 |
Tubing used w suction pump |
4,384 |
4,153 |
$16K |
| E2601 |
Gen w/c cushion wdth < 22 in |
445 |
382 |
$15K |
| B9998 |
Enteral supp not otherwise c |
959 |
610 |
$13K |
| A4217 |
Sterile water/saline, 500 ml |
402 |
374 |
$12K |
| A4629 |
Tracheostomy care kit |
142 |
128 |
$9K |
| T4525 |
Adult size pull-on sm |
129 |
112 |
$9K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
267 |
228 |
$8K |
| A7509 |
Heat & moisture exchange sys |
309 |
287 |
$8K |
| A4927 |
Non-sterile gloves |
1,380 |
993 |
$7K |
| A4322 |
Irrigation syringe |
390 |
307 |
$6K |
| A7003 |
Nebulizer administration set |
2,705 |
2,477 |
$6K |
| A4332 |
Lube sterile packet |
1,049 |
983 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
2,238 |
1,033 |
$6K |
| A4216 |
Sterile water/saline, 10 ml |
176 |
152 |
$4K |
| B4082 |
Enteral ng tubing w/o stylet |
268 |
247 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
253 |
217 |
$2K |
| A5120 |
Skin barrier, wipe or swab |
304 |
259 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
729 |
675 |
$661.42 |
| A4357 |
Bedside drainage bag |
88 |
72 |
$542.11 |
| E0163 |
Commode chair with fixed arm |
17 |
12 |
$458.65 |
| A4450 |
Non-waterproof tape |
143 |
121 |
$213.81 |
| A7525 |
Tracheostomy mask |
151 |
126 |
$145.78 |
| A7012 |
Nebulizer water collec devic |
12 |
12 |
$45.67 |
| E2208 |
Cylinder tank carrier |
34 |
25 |
$0.00 |