| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1726 |
Makena, 10 mg |
3,554 |
476 |
$2.45M |
| E1390 |
Oxygen concentrator |
21,767 |
18,981 |
$642K |
| B4035 |
Enteral feed supp pump per d |
4,315 |
3,317 |
$519K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,072 |
2,410 |
$502K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,720 |
2,773 |
$287K |
| B4153 |
Ef hydrolyzed/amino acids |
1,135 |
782 |
$258K |
| S9500 |
Hit antibiotic q24h diem |
11,710 |
573 |
$233K |
| B4034 |
Enter feed supkit syr by day |
3,587 |
2,715 |
$223K |
| A7030 |
Cpap full face mask |
6,210 |
5,100 |
$200K |
| B4150 |
Ef complet w/intact nutrient |
2,645 |
1,719 |
$186K |
| L4361 |
Pneuma/vac walk boot pre ots |
1,663 |
1,438 |
$170K |
| E0570 |
Nebulizer with compression |
17,340 |
15,354 |
$150K |
| E0601 |
Cont airway pressure device |
7,119 |
6,141 |
$140K |
| E0431 |
Portable gaseous 02 |
17,619 |
15,449 |
$119K |
| E0260 |
Hosp bed semi-electr w/ matt |
4,310 |
3,760 |
$75K |
| A4624 |
Tracheal suction tube |
858 |
723 |
$69K |
| K0001 |
Standard wheelchair |
7,342 |
6,378 |
$59K |
| A4351 |
Straight tip urine catheter |
440 |
371 |
$53K |
| E0562 |
Humidifier heated used w pap |
7,366 |
6,119 |
$53K |
| E0114 |
Crutch underarm pair no wood |
2,273 |
2,066 |
$51K |
| J1642 |
Inj heparin sodium per 10 u |
1,185 |
596 |
$48K |
| E0603 |
Electric breast pump |
170 |
166 |
$47K |
| B4154 |
Ef spec metabolic noninherit |
558 |
417 |
$46K |
| A7031 |
Replacement facemask interfa |
3,642 |
3,043 |
$41K |
| L8000 |
Mastectomy bra |
2,111 |
1,709 |
$39K |
| K0823 |
Pwc gp 2 std cap chair |
646 |
458 |
$39K |
| E0470 |
Rad w/o backup non-inv intfc |
1,267 |
1,118 |
$38K |
| A4629 |
Tracheostomy care kit |
621 |
521 |
$35K |
| E0630 |
Patient lift hydraulic |
1,897 |
1,715 |
$35K |
| A7037 |
Pos airway pressure tubing |
5,819 |
4,959 |
$33K |
| A7035 |
Pos airway press headgear |
4,547 |
3,779 |
$33K |
| E0143 |
Walker folding wheeled w/o s |
2,189 |
1,894 |
$32K |
| E0600 |
Suction pump portab hom modl |
1,903 |
1,694 |
$29K |
| A7034 |
Nasal application device |
1,263 |
1,085 |
$29K |
| A7000 |
Disposable canister for pump |
2,883 |
2,292 |
$28K |
| L3908 |
Who cock-up nonmolde pre ots |
1,206 |
881 |
$27K |
| K0006 |
Heavy duty wheelchair |
1,199 |
1,081 |
$25K |
| S9542 |
Ht inj noc per diem |
3,563 |
480 |
$23K |
| L8030 |
Breast prosthes w/o adhesive |
230 |
182 |
$23K |
| A7526 |
Tracheostomy tube collar |
1,283 |
1,087 |
$21K |
| A7038 |
Pos airway pressure filter |
10,739 |
9,038 |
$19K |
| B4088 |
Gastro/jejuno tube, low-pro |
820 |
619 |
$17K |
| E0465 |
Home vent invasive interface |
30 |
24 |
$17K |
| E2402 |
Neg press wound therapy pump |
50 |
41 |
$15K |
| K0738 |
Portable gas oxygen system |
1,200 |
1,055 |
$14K |
| A4604 |
Tubing with heating element |
965 |
723 |
$14K |
| A4223 |
Infusion supplies w/o pump |
386 |
38 |
$13K |
| E0261 |
Hosp bed semi-electr w/o mat |
893 |
834 |
$12K |
| A7046 |
Repl water chamber, pap dev |
2,926 |
2,461 |
$11K |
| S9343 |
Hit enteral bolus nurs |
1,433 |
241 |
$11K |
| K0195 |
Elevating whlchair leg rests |
2,546 |
2,158 |
$11K |
| L3809 |
Whfo w/o joints pre ots |
116 |
103 |
$10K |
| A4623 |
Tracheostomy inner cannula |
162 |
129 |
$9K |
| A7039 |
Filter, non disposable w pap |
3,317 |
2,807 |
$8K |
| E1028 |
W/c manual swingaway |
113 |
24 |
$8K |
| A4216 |
Sterile water/saline, 10 ml |
1,636 |
794 |
$8K |
| A4628 |
Oropharyngeal suction cath |
1,944 |
1,632 |
$8K |
| A7002 |
Tubing used w suction pump |
2,364 |
1,955 |
$7K |
| E0445 |
Oximeter non-invasive |
174 |
152 |
$7K |
| S5502 |
Hit interim cath care |
946 |
706 |
$6K |
| E0604 |
Hosp grade elec breast pump |
44 |
26 |
$6K |
| L1830 |
Ko immob canvas long pre ots |
107 |
102 |
$4K |
| A7032 |
Replacement nasal cushion |
352 |
297 |
$4K |
| A4606 |
Oxygen probe used w oximeter |
412 |
327 |
$4K |
| A7003 |
Nebulizer administration set |
2,191 |
1,888 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
1,086 |
753 |
$3K |
| E0973 |
W/ch access det adj armrest |
127 |
38 |
$2K |
| A7520 |
Trach/laryn tube non-cuffed |
85 |
77 |
$2K |
| K0108 |
W/c component-accessory nos |
45 |
14 |
$2K |
| E0955 |
Cushioned headrest |
24 |
12 |
$1K |
| J1644 |
Inj heparin sodium per 1000u |
329 |
198 |
$982.34 |
| A7504 |
Tracheostoma hmes filter |
62 |
51 |
$836.70 |
| A7012 |
Nebulizer water collec devic |
233 |
182 |
$790.48 |
| E0910 |
Trapeze bar attached to bed |
125 |
105 |
$543.04 |
| E0202 |
Phototherapy light w/ photom |
16 |
12 |
$459.71 |
| E0135 |
Walker folding adjust/fixed |
13 |
12 |
$373.49 |
| J7050 |
Normal saline solution infus |
682 |
357 |
$282.28 |
| A7525 |
Tracheostomy mask |
272 |
221 |
$233.74 |
| A7015 |
Aerosol mask used w nebulize |
182 |
158 |
$138.03 |
| A6197 |
Alginate drsg >16 <=48 sq in |
16 |
12 |
$115.80 |
| A6446 |
Conform band s w>=3" <5"/yd |
85 |
56 |
$94.40 |
| A5512 |
Multi den insert direct form |
26 |
12 |
$54.32 |
| A4450 |
Non-waterproof tape |
64 |
45 |
$51.10 |
| A5500 |
Diab shoe for density insert |
26 |
12 |
$44.36 |
| A7013 |
Disposable compressor filter |
15 |
13 |
$6.57 |