| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home vent invasive interface |
391 |
217 |
$264K |
| E1390 |
Oxygen concentrator |
2,620 |
1,471 |
$160K |
| B4161 |
Ef ped hydrolyzed/amino acid |
329 |
299 |
$146K |
| B4158 |
Ef ped complete intact nut |
1,057 |
931 |
$136K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,151 |
1,001 |
$115K |
| E0445 |
Oximeter non-invasive |
1,079 |
604 |
$109K |
| B4035 |
Enteral feed supp pump per d |
707 |
372 |
$97K |
| A4483 |
Moisture exchanger |
107 |
106 |
$36K |
| A4624 |
Tracheal suction tube |
165 |
146 |
$36K |
| E0431 |
Portable gaseous 02 |
1,567 |
910 |
$17K |
| A4217 |
Sterile water/saline, 500 ml |
316 |
247 |
$16K |
| A7520 |
Trach/laryn tube non-cuffed |
252 |
145 |
$10K |
| A7526 |
Tracheostomy tube collar |
224 |
190 |
$7K |
| J7626 |
Budesonide non-comp unit |
40 |
34 |
$3K |
| A4629 |
Tracheostomy care kit |
28 |
24 |
$3K |
| A7000 |
Disposable canister for pump |
232 |
215 |
$2K |
| E0601 |
Cont airway pressure device |
100 |
56 |
$2K |
| J7606 |
Formoterol fumarate, inh |
15 |
13 |
$2K |
| A4628 |
Oropharyngeal suction cath |
185 |
174 |
$2K |
| J7605 |
Arformoterol non-comp unit |
21 |
17 |
$2K |
| Q0513 |
Disp fee inhal drugs/30 days |
97 |
74 |
$2K |
| E0570 |
Nebulizer with compression |
171 |
138 |
$2K |
| B4088 |
Gastro/jejuno tube, low-pro |
16 |
15 |
$1K |
| E0562 |
Humidifier heated used w pap |
161 |
85 |
$1K |
| A7002 |
Tubing used w suction pump |
228 |
211 |
$1K |
| J7620 |
Albuterol ipratrop non-comp |
133 |
85 |
$542.70 |
| A7007 |
Lg vol nebulizer disposable |
163 |
85 |
$522.90 |
| A7003 |
Nebulizer administration set |
294 |
275 |
$444.76 |
| J7613 |
Albuterol non-comp unit |
52 |
40 |
$225.64 |
| A7525 |
Tracheostomy mask |
136 |
73 |
$114.57 |
| A7038 |
Pos airway pressure filter |
44 |
37 |
$95.15 |