| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,533 |
4,300 |
$877K |
| A9900 |
Supply/accessory/service |
14,511 |
10,152 |
$812K |
| T4534 |
Youth size pull-on |
4,773 |
4,603 |
$736K |
| A4554 |
Disposable underpads |
13,714 |
13,317 |
$648K |
| B4150 |
Ef complet w/intact nutrient |
2,952 |
2,825 |
$539K |
| T4526 |
Adult size pull-on med |
2,442 |
2,363 |
$351K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,341 |
1,284 |
$303K |
| T4527 |
Adult size pull-on lg |
1,798 |
1,692 |
$275K |
| T4522 |
Adult size brief/diaper med |
2,238 |
2,162 |
$270K |
| T4533 |
Youth size brief/diaper |
2,103 |
2,041 |
$254K |
| A4927 |
Non-sterile gloves |
21,804 |
20,994 |
$245K |
| B4034 |
Enter feed supkit syr by day |
1,447 |
1,387 |
$184K |
| T4521 |
Adult size brief/diaper sm |
1,357 |
1,279 |
$152K |
| E1399 |
Durable medical equipment mi |
201 |
121 |
$151K |
| A4624 |
Tracheal suction tube |
1,145 |
1,063 |
$103K |
| T4523 |
Adult size brief/diaper lg |
571 |
553 |
$75K |
| B4088 |
Gastro/jejuno tube, low-pro |
617 |
567 |
$58K |
| A4213 |
20+ cc syringe only |
379 |
367 |
$17K |
| T4535 |
Disposable liner/shield/pad |
338 |
315 |
$10K |
| E0255 |
Hospital bed var ht w/ mattr |
106 |
103 |
$8K |
| A7003 |
Nebulizer administration set |
854 |
807 |
$6K |
| B9998 |
Enteral supp not otherwise c |
99 |
96 |
$3K |
| A7002 |
Tubing used w suction pump |
1,263 |
1,189 |
$3K |
| T4530 |
Ped size brief/diaper lg |
12 |
12 |
$2K |
| E0630 |
Patient lift hydraulic |
39 |
36 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
679 |
649 |
$758.43 |
| A6402 |
Sterile gauze <= 16 sq in |
51 |
50 |
$696.00 |
| A4245 |
Alcohol wipes per box |
103 |
98 |
$624.92 |
| E0600 |
Suction pump portab hom modl |
16 |
13 |
$364.68 |
| A4930 |
Sterile, gloves per pair |
12 |
12 |
$289.00 |
| A7000 |
Disposable canister for pump |
36 |
36 |
$201.34 |