| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
15,557 |
7,971 |
$3.88M |
| B4035 |
Enteral feed supp pump per d |
53,205 |
15,418 |
$3.63M |
| E1399 |
Durable medical equipment mi |
4,552 |
1,557 |
$2.84M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
28,283 |
17,449 |
$2.78M |
| B9998 |
Enteral supp not otherwise c |
37,912 |
6,852 |
$2.39M |
| B4149 |
Ef blenderized foods |
7,527 |
5,689 |
$2.22M |
| E0465 |
Home vent invasive interface |
2,459 |
2,068 |
$2.14M |
| A4353 |
Intermittent urinary cath |
4,010 |
3,226 |
$2.09M |
| E0445 |
Oximeter non-invasive |
8,445 |
7,497 |
$2.06M |
| E1390 |
Oxygen concentrator |
18,097 |
16,432 |
$1.60M |
| B4034 |
Enter feed supkit syr by day |
25,818 |
12,782 |
$1.44M |
| K0108 |
W/c component-accessory nos |
5,562 |
1,588 |
$1.12M |
| A4351 |
Straight tip urine catheter |
7,166 |
6,272 |
$963K |
| T4534 |
Youth size pull-on |
8,844 |
8,356 |
$922K |
| E0471 |
Rad w/backup non inv intrfc |
3,038 |
2,798 |
$877K |
| T4521 |
Adult size brief/diaper sm |
6,278 |
5,886 |
$804K |
| A4352 |
Coude tip urinary catheter |
1,982 |
1,709 |
$766K |
| A4606 |
Oxygen probe used w oximeter |
29,891 |
7,613 |
$688K |
| T4522 |
Adult size brief/diaper med |
5,497 |
5,114 |
$686K |
| B4150 |
Ef complet w/intact nutrient |
9,614 |
4,438 |
$654K |
| B4036 |
Enteral feed sup kit grav by |
7,959 |
4,402 |
$645K |
| E0466 |
Home vent non-invasive inter |
641 |
538 |
$629K |
| A4312 |
Cath w/o bag 2-way silicone |
23,104 |
2,171 |
$599K |
| A4483 |
Moisture exchanger |
1,631 |
1,444 |
$589K |
| E1028 |
W/c manual swingaway |
2,015 |
1,289 |
$566K |
| A4222 |
Infusion supplies with pump |
3,912 |
1,651 |
$564K |
| B4154 |
Ef spec metabolic noninherit |
3,386 |
1,800 |
$553K |
| B4153 |
Ef hydrolyzed/amino acids |
2,391 |
985 |
$552K |
| B4152 |
Ef calorie dense>/=1.5kcal |
6,324 |
3,511 |
$540K |
| B4162 |
Ef ped specmetabolic inherit |
1,399 |
1,088 |
$531K |
| B4088 |
Gastro/jejuno tube, low-pro |
5,772 |
5,010 |
$509K |
| T4530 |
Ped size brief/diaper lg |
6,831 |
6,374 |
$482K |
| E1236 |
Folding ped wc adjustable |
885 |
782 |
$477K |
| T4541 |
Large disposable underpad |
11,279 |
10,646 |
$419K |
| B9002 |
Enter nutr inf pump any type |
4,444 |
3,844 |
$370K |
| T4523 |
Adult size brief/diaper lg |
2,483 |
2,344 |
$353K |
| K0738 |
Portable gas oxygen system |
7,313 |
6,781 |
$311K |
| Y2032 |
|
906 |
812 |
$305K |
| T4532 |
Ped size pull-on lg |
3,804 |
3,639 |
$296K |
| A4247 |
Betadine/iodine swabs/wipes |
3,049 |
2,690 |
$286K |
| B4155 |
Ef incomplete/modular |
6,382 |
5,057 |
$271K |
| T4525 |
Adult size pull-on sm |
2,354 |
2,225 |
$265K |
| E0482 |
Cough stimulating device |
696 |
644 |
$260K |
| A4624 |
Tracheal suction tube |
2,598 |
2,350 |
$259K |
| E0431 |
Portable gaseous 02 |
7,755 |
7,268 |
$253K |
| B4158 |
Ef ped complete intact nut |
3,024 |
1,875 |
$247K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,772 |
1,562 |
$243K |
| T4529 |
Ped size brief/diaper sm/med |
2,937 |
2,756 |
$231K |
| T4526 |
Adult size pull-on med |
1,921 |
1,800 |
$231K |
| A7520 |
Trach/laryn tube non-cuffed |
2,406 |
2,011 |
$221K |
| A7526 |
Tracheostomy tube collar |
2,710 |
2,378 |
$216K |
| E0781 |
External ambulatory infus pu |
16,030 |
1,031 |
$215K |
| A4927 |
Non-sterile gloves |
5,331 |
4,744 |
$183K |
| E0955 |
Cushioned headrest |
1,246 |
890 |
$171K |
| K0003 |
Lightweight wheelchair |
2,235 |
2,185 |
$169K |
| E0601 |
Cont airway pressure device |
2,508 |
2,377 |
$166K |
| A7507 |
Integrated filter & holder |
1,628 |
875 |
$155K |
| T4535 |
Disposable liner/shield/pad |
3,390 |
3,132 |
$148K |
| E0570 |
Nebulizer with compression |
1,568 |
1,472 |
$147K |
| B4224 |
Parenteral administration ki |
5,059 |
281 |
$141K |
| A4221 |
Supp non-insulin inf cath/wk |
6,811 |
3,019 |
$130K |
| B4103 |
Ef ped fluid and electrolyte |
3,301 |
2,653 |
$124K |
| E0960 |
W/c shoulder harness/straps |
1,561 |
1,097 |
$116K |
| T4531 |
Ped size pull-on sm/med |
1,054 |
1,016 |
$109K |
| A7000 |
Disposable canister for pump |
4,959 |
4,427 |
$108K |
| A4385 |
Ost skn barrier sld ext wear |
1,030 |
882 |
$107K |
| T4527 |
Adult size pull-on lg |
780 |
736 |
$104K |
| T4528 |
Adult size pull-on xl |
630 |
591 |
$102K |
| A6549 |
Grad com garm noc day use |
412 |
238 |
$101K |
| E0971 |
Wheelchair anti-tipping devi |
2,945 |
2,433 |
$100K |
| A4217 |
Sterile water/saline, 500 ml |
1,519 |
1,260 |
$99K |
| A4322 |
Irrigation syringe |
3,024 |
2,220 |
$87K |
| K0040 |
Adjustable angle footplate |
832 |
562 |
$86K |
| A4357 |
Bedside drainage bag |
7,415 |
3,006 |
$80K |
| A7521 |
Trach/laryn tube cuffed |
1,103 |
548 |
$80K |
| K0001 |
Standard wheelchair |
1,672 |
1,549 |
$79K |
| B4100 |
Food thickener oral |
1,181 |
847 |
$73K |
| E0973 |
W/ch access det adj armrest |
482 |
319 |
$72K |
| T4533 |
Youth size brief/diaper |
526 |
509 |
$65K |
| A4213 |
20+ cc syringe only |
2,404 |
1,898 |
$60K |
| E0600 |
Suction pump portab hom modl |
533 |
442 |
$60K |
| A7002 |
Tubing used w suction pump |
5,049 |
4,709 |
$59K |
| A6216 |
Non-sterile gauze<=16 sq in |
4,260 |
3,567 |
$57K |
| E0978 |
W/c acc,saf belt pelv strap |
1,862 |
1,295 |
$57K |
| A4344 |
Cath indw foley 2 way silicn |
1,868 |
242 |
$55K |
| A4362 |
Solid skin barrier |
494 |
435 |
$55K |
| B4220 |
Parenteral supply kit premix |
4,743 |
261 |
$42K |
| A4406 |
Pectin based ostomy paste |
1,583 |
1,342 |
$39K |
| T4537 |
Reusable underpad bed size |
508 |
500 |
$39K |
| A4425 |
Ost pch drain for barrier fl |
618 |
492 |
$38K |
| A7005 |
Nondisposable nebulizer set |
2,007 |
983 |
$35K |
| E0562 |
Humidifier heated used w pap |
398 |
358 |
$30K |
| A5063 |
Drain ostomy pouch w/flange |
505 |
401 |
$30K |
| E0143 |
Walker folding wheeled w/o s |
580 |
555 |
$29K |
| K0195 |
Elevating whlchair leg rests |
1,423 |
1,286 |
$28K |
| A4332 |
Lube sterile packet |
2,176 |
1,847 |
$27K |
| E0776 |
Iv pole |
2,608 |
2,153 |
$26K |
| E0260 |
Hosp bed semi-electr w/ matt |
303 |
275 |
$24K |
| K0739 |
Repair/svc dme non-oxygen eq |
237 |
173 |
$20K |
| E0956 |
W/c lateral trunk/hip suppor |
89 |
43 |
$18K |
| E0565 |
Compressor air power source |
335 |
306 |
$17K |
| S9340 |
Hit enteral per diem |
16 |
16 |
$16K |
| E0990 |
Wheelchair elevating leg res |
663 |
578 |
$15K |
| A5120 |
Skin barrier, wipe or swab |
2,470 |
2,085 |
$15K |
| A4452 |
Waterproof tape |
584 |
508 |
$10K |
| E1226 |
Manual fully reclining back |
218 |
199 |
$10K |
| E2609 |
Custom fabricate w/c cushion |
14 |
12 |
$10K |
| E0950 |
Tray |
168 |
126 |
$10K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
91 |
76 |
$9K |
| A4223 |
Infusion supplies w/o pump |
179 |
68 |
$9K |
| A4371 |
Skin barrier powder per oz |
1,599 |
1,401 |
$7K |
| T4524 |
Adult size brief/diaper xl |
56 |
54 |
$7K |
| A4216 |
Sterile water/saline, 10 ml |
418 |
374 |
$7K |
| A7037 |
Pos airway pressure tubing |
263 |
252 |
$6K |
| B4157 |
Ef special metabolic inherit |
14 |
12 |
$6K |
| A6402 |
Sterile gauze <= 16 sq in |
594 |
548 |
$4K |
| A6212 |
Foam drg <=16 sq in w/border |
18 |
13 |
$4K |
| A7015 |
Aerosol mask used w nebulize |
2,332 |
1,121 |
$4K |
| E0561 |
Humidifier nonheated w pap |
218 |
198 |
$4K |
| B4081 |
Enteral ng tubing w/ stylet |
182 |
95 |
$4K |
| A7004 |
Disposable nebulizer sml vol |
1,399 |
756 |
$3K |
| E1392 |
Portable oxygen concentrator |
102 |
96 |
$3K |
| E0630 |
Patient lift hydraulic |
27 |
26 |
$3K |
| A7003 |
Nebulizer administration set |
725 |
542 |
$2K |
| A7034 |
Nasal application device |
45 |
40 |
$2K |
| A4628 |
Oropharyngeal suction cath |
168 |
158 |
$2K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
12 |
12 |
$2K |
| A4333 |
Urinary cath anchor device |
36 |
27 |
$1K |
| A4629 |
Tracheostomy care kit |
13 |
12 |
$1K |
| E0966 |
Wheelchair head rest extensi |
20 |
14 |
$994.17 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
49 |
39 |
$682.63 |
| A7525 |
Tracheostomy mask |
446 |
199 |
$670.79 |
| K0038 |
Leg strap each |
36 |
25 |
$665.18 |
| A9286 |
Any hygienic item, device |
226 |
202 |
$628.61 |
| A4402 |
Lubricant per ounce |
43 |
38 |
$144.76 |
| A7038 |
Pos airway pressure filter |
25 |
25 |
$69.15 |
| A6445 |
Conform band s w <3"/yd |
14 |
12 |
$67.96 |
| A4456 |
Adhesive remover, wipes |
14 |
13 |
$55.52 |
| A9999 |
Dme supply or accessory, nos |
63 |
54 |
$31.14 |