| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
2,658 |
2,596 |
$2.13M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
5,993 |
5,849 |
$1.50M |
| B4035 |
Enteral feed supp pump per d |
5,379 |
5,141 |
$1.43M |
| E1390 |
Oxygen concentrator |
13,372 |
13,105 |
$1.22M |
| B4153 |
Ef hydrolyzed/amino acids |
490 |
486 |
$655K |
| B9998 |
Enteral supp not otherwise c |
8,243 |
6,834 |
$578K |
| A4554 |
Disposable underpads |
12,538 |
12,364 |
$403K |
| B4155 |
Ef incomplete/modular |
953 |
920 |
$317K |
| T4528 |
Adult size pull-on xl |
1,623 |
1,594 |
$287K |
| B4149 |
Ef blenderized foods |
694 |
662 |
$268K |
| T4534 |
Youth size pull-on |
2,515 |
2,473 |
$265K |
| T4527 |
Adult size pull-on lg |
1,941 |
1,901 |
$260K |
| B4150 |
Ef complet w/intact nutrient |
885 |
861 |
$241K |
| E0601 |
Cont airway pressure device |
5,147 |
5,095 |
$238K |
| T4526 |
Adult size pull-on med |
2,272 |
2,241 |
$236K |
| E0570 |
Nebulizer with compression |
4,630 |
4,553 |
$228K |
| E0445 |
Oximeter non-invasive |
1,736 |
1,649 |
$208K |
| E0431 |
Portable gaseous 02 |
10,965 |
10,707 |
$185K |
| B9002 |
Enter nutr inf pump any type |
1,445 |
1,431 |
$178K |
| T4523 |
Adult size brief/diaper lg |
1,427 |
1,405 |
$148K |
| T4522 |
Adult size brief/diaper med |
1,555 |
1,530 |
$147K |
| K0001 |
Standard wheelchair |
2,840 |
2,767 |
$136K |
| T4530 |
Ped size brief/diaper lg |
1,322 |
1,302 |
$120K |
| B4152 |
Ef calorie dense>/=1.5kcal |
362 |
348 |
$120K |
| A7030 |
Cpap full face mask |
1,567 |
1,525 |
$111K |
| A4335 |
Incontinence supply |
19,420 |
19,188 |
$96K |
| T4535 |
Disposable liner/shield/pad |
2,283 |
2,197 |
$90K |
| A4351 |
Straight tip urine catheter |
459 |
445 |
$78K |
| A4606 |
Oxygen probe used w oximeter |
793 |
730 |
$73K |
| E0562 |
Humidifier heated used w pap |
1,752 |
1,736 |
$73K |
| A7031 |
Replacement facemask interfa |
2,217 |
2,037 |
$63K |
| T4521 |
Adult size brief/diaper sm |
684 |
650 |
$60K |
| A7000 |
Disposable canister for pump |
1,622 |
1,595 |
$52K |
| A4322 |
Irrigation syringe |
5,438 |
5,334 |
$45K |
| E0277 |
Powered pres-redu air mattrs |
103 |
103 |
$35K |
| E0143 |
Walker folding wheeled w/o s |
537 |
521 |
$29K |
| A7002 |
Tubing used w suction pump |
1,818 |
1,746 |
$24K |
| A4239 |
Non-adju cgm supply allow |
149 |
141 |
$24K |
| E0260 |
Hosp bed semi-electr w/ matt |
196 |
190 |
$23K |
| T4525 |
Adult size pull-on sm |
260 |
259 |
$23K |
| T4532 |
Ped size pull-on lg |
152 |
151 |
$23K |
| A7005 |
Nondisposable nebulizer set |
1,303 |
1,266 |
$21K |
| A7034 |
Nasal application device |
499 |
481 |
$18K |
| A7035 |
Pos airway press headgear |
1,425 |
1,387 |
$18K |
| A7037 |
Pos airway pressure tubing |
901 |
866 |
$16K |
| T1999 |
Noc retail items andsupplies |
5,222 |
4,359 |
$15K |
| A4927 |
Non-sterile gloves |
2,577 |
2,536 |
$15K |
| A6402 |
Sterile gauze <= 16 sq in |
1,507 |
1,481 |
$14K |
| A7038 |
Pos airway pressure filter |
3,349 |
3,078 |
$12K |
| E0776 |
Iv pole |
1,122 |
1,114 |
$10K |
| A4628 |
Oropharyngeal suction cath |
1,949 |
1,922 |
$10K |
| A7003 |
Nebulizer administration set |
3,193 |
3,158 |
$9K |
| K0195 |
Elevating whlchair leg rests |
597 |
466 |
$8K |
| T4524 |
Adult size brief/diaper xl |
59 |
58 |
$7K |
| A7046 |
Repl water chamber, pap dev |
1,295 |
1,262 |
$7K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
293 |
277 |
$6K |
| A6250 |
Skin seal protect moisturizr |
990 |
972 |
$6K |
| A7015 |
Aerosol mask used w nebulize |
4,752 |
4,615 |
$5K |
| E0114 |
Crutch underarm pair no wood |
180 |
178 |
$5K |
| A7032 |
Replacement nasal cushion |
173 |
154 |
$4K |
| A4450 |
Non-waterproof tape |
812 |
793 |
$4K |
| B4103 |
Ef ped fluid and electrolyte |
12 |
12 |
$3K |
| A4604 |
Tubing with heating element |
1,185 |
1,168 |
$3K |
| B4158 |
Ef ped complete intact nut |
13 |
12 |
$3K |
| A4452 |
Waterproof tape |
132 |
122 |
$2K |
| L4361 |
Pneuma/vac walk boot pre ots |
15 |
15 |
$2K |
| A6216 |
Non-sterile gauze<=16 sq in |
247 |
243 |
$2K |
| E0470 |
Rad w/o backup non-inv intfc |
12 |
12 |
$1K |
| A7013 |
Disposable compressor filter |
2,286 |
2,225 |
$1K |
| E1392 |
Portable oxygen concentrator |
194 |
192 |
$580.48 |
| A7033 |
Replacement nasal pillows |
27 |
25 |
$141.51 |
| E1399 |
Durable medical equipment mi |
61 |
55 |
$45.10 |