| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
7,569 |
6,815 |
$2.62M |
| A9276 |
Disposable sensor, cgm sys |
6,285 |
4,964 |
$2.61M |
| B4035 |
Enteral feed supp pump per d |
10,173 |
9,484 |
$2.40M |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,366 |
2,857 |
$2.29M |
| B4149 |
Ef blenderized foods |
3,744 |
3,360 |
$1.30M |
| B4154 |
Ef spec metabolic noninherit |
5,546 |
4,426 |
$1.14M |
| A4554 |
Disposable underpads |
25,578 |
21,653 |
$924K |
| T4534 |
Youth size pull-on |
5,690 |
5,501 |
$877K |
| B4088 |
Gastro/jejuno tube, low-pro |
5,869 |
5,105 |
$820K |
| E0601 |
Cont airway pressure device |
10,239 |
6,801 |
$817K |
| A9277 |
External transmitter, cgm |
1,263 |
1,017 |
$772K |
| B4150 |
Ef complet w/intact nutrient |
7,176 |
5,707 |
$690K |
| T4527 |
Adult size pull-on lg |
6,163 |
4,755 |
$668K |
| B9998 |
Enteral supp not otherwise c |
10,192 |
8,821 |
$652K |
| A4927 |
Non-sterile gloves |
27,715 |
23,421 |
$537K |
| A7030 |
Cpap full face mask |
4,657 |
3,331 |
$527K |
| T4526 |
Adult size pull-on med |
5,483 |
4,253 |
$527K |
| T4535 |
Disposable liner/shield/pad |
11,429 |
9,452 |
$478K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,148 |
2,531 |
$449K |
| E0562 |
Humidifier heated used w pap |
2,103 |
1,401 |
$397K |
| T4522 |
Adult size brief/diaper med |
3,668 |
3,471 |
$396K |
| B4155 |
Ef incomplete/modular |
3,405 |
2,821 |
$370K |
| T4528 |
Adult size pull-on xl |
3,374 |
2,773 |
$354K |
| T4523 |
Adult size brief/diaper lg |
2,586 |
2,253 |
$340K |
| B4158 |
Ef ped complete intact nut |
1,367 |
1,137 |
$322K |
| A6250 |
Skin seal protect moisturizr |
27,793 |
22,380 |
$298K |
| A7031 |
Replacement facemask interfa |
4,728 |
3,671 |
$269K |
| K0108 |
W/c component-accessory nos |
778 |
528 |
$246K |
| B4153 |
Ef hydrolyzed/amino acids |
313 |
283 |
$220K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,735 |
1,520 |
$213K |
| B9002 |
Enter nutr inf pump any type |
819 |
750 |
$204K |
| B4034 |
Enter feed supkit syr by day |
1,335 |
1,276 |
$180K |
| E0143 |
Walker folding wheeled w/o s |
3,135 |
2,851 |
$153K |
| T4521 |
Adult size brief/diaper sm |
1,276 |
1,212 |
$144K |
| T4525 |
Adult size pull-on sm |
1,728 |
1,590 |
$144K |
| A7034 |
Nasal application device |
2,490 |
1,774 |
$144K |
| T4524 |
Adult size brief/diaper xl |
923 |
884 |
$123K |
| A9278 |
External receiver, cgm sys |
250 |
185 |
$122K |
| A7035 |
Pos airway press headgear |
4,685 |
3,147 |
$116K |
| A4604 |
Tubing with heating element |
3,059 |
2,503 |
$114K |
| A7037 |
Pos airway pressure tubing |
3,884 |
2,400 |
$105K |
| T4533 |
Youth size brief/diaper |
996 |
964 |
$100K |
| A7038 |
Pos airway pressure filter |
7,763 |
5,591 |
$87K |
| T4530 |
Ped size brief/diaper lg |
1,020 |
961 |
$81K |
| B4100 |
Food thickener oral |
885 |
747 |
$71K |
| E0114 |
Crutch underarm pair no wood |
1,515 |
1,381 |
$71K |
| A7032 |
Replacement nasal cushion |
1,695 |
1,347 |
$56K |
| A9286 |
Any hygienic item, device |
2,494 |
2,471 |
$51K |
| E1399 |
Durable medical equipment mi |
38 |
31 |
$48K |
| E1028 |
W/c manual swingaway |
225 |
160 |
$46K |
| T4544 |
Adlt disp und/pull on abv xl |
222 |
205 |
$36K |
| E1390 |
Oxygen concentrator |
5,038 |
3,158 |
$25K |
| A9900 |
Supply/accessory/service |
275 |
217 |
$23K |
| B4104 |
Additive for enteral formula |
335 |
293 |
$22K |
| K0001 |
Standard wheelchair |
650 |
551 |
$21K |
| T4529 |
Ped size brief/diaper sm/med |
266 |
264 |
$21K |
| T4531 |
Ped size pull-on sm/med |
169 |
166 |
$14K |
| A7033 |
Replacement nasal pillows |
378 |
330 |
$14K |
| E0470 |
Rad w/o backup non-inv intfc |
98 |
82 |
$13K |
| L4361 |
Pneuma/vac walk boot pre ots |
58 |
56 |
$11K |
| B4102 |
Ef adult fluids and electro |
610 |
512 |
$11K |
| K0002 |
Stnd hemi (low seat) whlchr |
237 |
202 |
$10K |
| A9901 |
Delivery/set up/dispensing |
581 |
407 |
$8K |
| E0973 |
W/ch access det adj armrest |
49 |
27 |
$5K |
| A4351 |
Straight tip urine catheter |
34 |
25 |
$4K |
| K0738 |
Portable gas oxygen system |
2,306 |
1,513 |
$4K |
| E0260 |
Hosp bed semi-electr w/ matt |
59 |
49 |
$3K |
| L3809 |
Whfo w/o joints pre ots |
15 |
14 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
127 |
79 |
$2K |
| E0441 |
Stationary o2 contents, gas |
40 |
40 |
$2K |
| A7039 |
Filter, non disposable w pap |
197 |
190 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
81 |
59 |
$2K |
| E0156 |
Walker seat attachment |
150 |
126 |
$2K |
| L3908 |
Who cock-up nonmolde pre ots |
56 |
52 |
$2K |
| E0955 |
Cushioned headrest |
26 |
13 |
$1K |
| A7046 |
Repl water chamber, pap dev |
2,934 |
2,080 |
$831.73 |
| E0570 |
Nebulizer with compression |
55 |
55 |
$589.58 |
| K0195 |
Elevating whlchair leg rests |
86 |
77 |
$456.17 |
| E0951 |
Loop heel |
82 |
40 |
$358.34 |
| E0431 |
Portable gaseous 02 |
248 |
190 |
$344.38 |
| E0730 |
Tens four lead |
15 |
15 |
$49.29 |
| E1392 |
Portable oxygen concentrator |
429 |
367 |
$7.67 |
| A4520 |
Incontinence garment anytype |
48 |
46 |
$0.00 |