| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
6,039 |
5,548 |
$1.53M |
| E0465 |
Home vent invasive interface |
2,141 |
1,825 |
$1.37M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,860 |
1,571 |
$1.10M |
| B4149 |
Ef blenderized foods |
1,733 |
1,518 |
$532K |
| A4605 |
Trach suction cath close sys |
1,390 |
1,335 |
$513K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,109 |
1,853 |
$510K |
| E1390 |
Oxygen concentrator |
3,611 |
3,059 |
$431K |
| A4624 |
Tracheal suction tube |
1,169 |
1,077 |
$419K |
| A7507 |
Integrated filter & holder |
1,716 |
1,590 |
$274K |
| A9900 |
Supply/accessory/service |
731 |
588 |
$225K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,937 |
1,772 |
$214K |
| E0443 |
Portable 02 contents, gas |
3,168 |
2,824 |
$197K |
| A7526 |
Tracheostomy tube collar |
2,714 |
2,560 |
$178K |
| A4629 |
Tracheostomy care kit |
1,325 |
1,255 |
$129K |
| E0431 |
Portable gaseous 02 |
5,717 |
4,811 |
$117K |
| T4541 |
Large disposable underpad |
1,528 |
1,452 |
$92K |
| A4649 |
Surgical supplies |
3,265 |
2,286 |
$69K |
| A7520 |
Trach/laryn tube non-cuffed |
971 |
900 |
$65K |
| T4522 |
Adult size brief/diaper med |
588 |
557 |
$60K |
| B9002 |
Enter nutr inf pump any type |
909 |
779 |
$54K |
| E0445 |
Oximeter non-invasive |
955 |
801 |
$46K |
| A4216 |
Sterile water/saline, 10 ml |
1,629 |
1,532 |
$39K |
| A6402 |
Sterile gauze <= 16 sq in |
2,258 |
2,056 |
$38K |
| A7000 |
Disposable canister for pump |
2,815 |
2,649 |
$36K |
| E0601 |
Cont airway pressure device |
598 |
515 |
$31K |
| A4927 |
Non-sterile gloves |
2,273 |
2,033 |
$30K |
| A7521 |
Trach/laryn tube cuffed |
414 |
394 |
$28K |
| B4034 |
Enter feed supkit syr by day |
142 |
139 |
$22K |
| A7002 |
Tubing used w suction pump |
3,483 |
3,260 |
$20K |
| A7038 |
Pos airway pressure filter |
3,192 |
2,964 |
$18K |
| T4521 |
Adult size brief/diaper sm |
251 |
204 |
$17K |
| E0600 |
Suction pump portab hom modl |
655 |
527 |
$15K |
| B4036 |
Enteral feed sup kit grav by |
119 |
94 |
$14K |
| A4217 |
Sterile water/saline, 500 ml |
1,238 |
1,131 |
$12K |
| E0562 |
Humidifier heated used w pap |
639 |
562 |
$12K |
| A7003 |
Nebulizer administration set |
3,016 |
2,891 |
$11K |
| A7046 |
Repl water chamber, pap dev |
758 |
709 |
$10K |
| A4452 |
Waterproof tape |
508 |
471 |
$9K |
| A4332 |
Lube sterile packet |
515 |
466 |
$9K |
| A9999 |
Dme supply or accessory, nos |
297 |
228 |
$6K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
84 |
63 |
$6K |
| A4628 |
Oropharyngeal suction cath |
2,778 |
2,556 |
$5K |
| A6453 |
Self-adher band w <3"/yd |
1,078 |
934 |
$4K |
| A4657 |
Syringe w/wo needle |
1,943 |
1,744 |
$4K |
| T4530 |
Ped size brief/diaper lg |
30 |
27 |
$4K |
| E0776 |
Iv pole |
485 |
387 |
$3K |
| A7012 |
Nebulizer water collec devic |
350 |
308 |
$2K |
| A7035 |
Pos airway press headgear |
91 |
86 |
$2K |
| A4450 |
Non-waterproof tape |
516 |
466 |
$2K |
| A7525 |
Tracheostomy mask |
589 |
529 |
$1K |
| A4606 |
Oxygen probe used w oximeter |
125 |
69 |
$1K |
| A4322 |
Irrigation syringe |
203 |
179 |
$1K |
| A7037 |
Pos airway pressure tubing |
37 |
37 |
$904.93 |
| A7039 |
Filter, non disposable w pap |
59 |
56 |
$587.86 |
| A7015 |
Aerosol mask used w nebulize |
310 |
308 |
$418.26 |
| E0565 |
Compressor air power source |
21 |
12 |
$395.77 |
| A6448 |
Lt compres band <3"/yd |
50 |
50 |
$366.43 |
| A7010 |
Disposable corrugated tubing |
13 |
13 |
$236.94 |
| A6219 |
Gauze <= 16 sq in w/border |
65 |
63 |
$96.44 |