| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,172 |
1,103 |
$232K |
| T4544 |
Adlt disp und/pull on abv xl |
1,019 |
979 |
$139K |
| T4543 |
Adult disp brief/diap abv xl |
896 |
830 |
$122K |
| B4154 |
Ef spec metabolic noninherit |
1,228 |
1,123 |
$112K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,004 |
960 |
$74K |
| E0570 |
Nebulizer with compression |
1,880 |
1,782 |
$70K |
| T4541 |
Large disposable underpad |
1,846 |
1,731 |
$69K |
| B4150 |
Ef complet w/intact nutrient |
889 |
854 |
$64K |
| A4670 |
Automatic bp monitor, dial |
989 |
931 |
$32K |
| A4927 |
Non-sterile gloves |
1,876 |
1,730 |
$14K |
| A4554 |
Disposable underpads |
332 |
311 |
$8K |
| E0445 |
Oximeter non-invasive |
14 |
14 |
$4K |
| A7016 |
Nebulizer dome & mouthpiece |
927 |
893 |
$3K |
| T4528 |
Adult size pull-on xl |
26 |
26 |
$2K |
| T4527 |
Adult size pull-on lg |
12 |
12 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
745 |
724 |
$688.75 |
| T4526 |
Adult size pull-on med |
14 |
14 |
$642.60 |
| E0605 |
Vaporizer room type |
12 |
12 |
$155.37 |
| Q0513 |
Disp fee inhal drugs/30 days |
502 |
498 |
$14.85 |
| G0008 |
Admin influenza virus vac |
16 |
16 |
$0.00 |
| J7626 |
Budesonide non-comp unit |
38 |
37 |
$0.00 |
| J7605 |
Arformoterol non-comp unit |
42 |
38 |
$0.00 |
| 90688 |
|
15 |
15 |
$0.00 |