| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
8,057 |
4,220 |
$671K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,748 |
5,789 |
$621K |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,446 |
1,115 |
$607K |
| E1390 |
Oxygen concentrator |
8,938 |
5,816 |
$348K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,916 |
2,563 |
$279K |
| B4150 |
Ef complet w/intact nutrient |
2,116 |
1,697 |
$160K |
| B4034 |
Enter feed supkit syr by day |
3,744 |
2,023 |
$139K |
| B4154 |
Ef spec metabolic noninherit |
853 |
553 |
$108K |
| E0601 |
Cont airway pressure device |
2,740 |
1,592 |
$56K |
| B4155 |
Ef incomplete/modular |
343 |
266 |
$51K |
| B4088 |
Gastro/jejuno tube, low-pro |
425 |
371 |
$38K |
| A7030 |
Cpap full face mask |
762 |
514 |
$24K |
| E0431 |
Portable gaseous 02 |
4,076 |
2,622 |
$22K |
| E0562 |
Humidifier heated used w pap |
2,477 |
1,459 |
$17K |
| B4149 |
Ef blenderized foods |
42 |
37 |
$15K |
| A7031 |
Replacement facemask interfa |
1,195 |
745 |
$14K |
| E1392 |
Portable oxygen concentrator |
1,065 |
671 |
$13K |
| A7035 |
Pos airway press headgear |
1,032 |
732 |
$10K |
| A7038 |
Pos airway pressure filter |
3,255 |
2,350 |
$8K |
| E0570 |
Nebulizer with compression |
1,903 |
1,485 |
$8K |
| A7037 |
Pos airway pressure tubing |
535 |
373 |
$6K |
| A7034 |
Nasal application device |
179 |
127 |
$4K |
| A4604 |
Tubing with heating element |
456 |
309 |
$2K |
| E0776 |
Iv pole |
42 |
25 |
$144.03 |
| A7003 |
Nebulizer administration set |
452 |
296 |
$118.95 |
| A7046 |
Repl water chamber, pap dev |
93 |
64 |
$118.86 |
| A7005 |
Nondisposable nebulizer set |
17 |
13 |
$43.89 |