| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7170 |
Inj., emicizumab-kxwh 0.5 mg |
164 |
125 |
$4.95M |
| 90378 |
|
1,299 |
815 |
$3.15M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
13,847 |
8,994 |
$1.29M |
| B4035 |
Enteral feed supp pump per d |
7,186 |
6,322 |
$1.28M |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,568 |
2,684 |
$1.11M |
| G0299 |
Hhs/hospice of rn ea 15 min |
12,801 |
5,881 |
$537K |
| G0151 |
Hhcp-serv of pt,ea 15 min |
7,652 |
2,770 |
$490K |
| G0153 |
Hhcp-svs of s/l path,ea 15mn |
7,703 |
2,506 |
$482K |
| E0603 |
Electric breast pump |
2,378 |
2,335 |
$451K |
| G0152 |
Hhcp-serv of ot,ea 15 min |
6,612 |
2,293 |
$429K |
| T4534 |
Youth size pull-on |
4,682 |
4,465 |
$377K |
| B4034 |
Enter feed supkit syr by day |
2,721 |
2,451 |
$265K |
| B4149 |
Ef blenderized foods |
886 |
706 |
$217K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,938 |
1,847 |
$207K |
| T4530 |
Ped size brief/diaper lg |
2,421 |
2,297 |
$199K |
| T4533 |
Youth size brief/diaper |
2,181 |
2,053 |
$197K |
| T4527 |
Adult size pull-on lg |
1,371 |
1,314 |
$157K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,985 |
1,141 |
$153K |
| B4100 |
Food thickener oral |
1,469 |
1,238 |
$136K |
| B9002 |
Enter nutr inf pump any type |
1,770 |
1,688 |
$122K |
| T4522 |
Adult size brief/diaper med |
976 |
917 |
$112K |
| B9998 |
Enteral supp not otherwise c |
728 |
574 |
$106K |
| E0570 |
Nebulizer with compression |
784 |
772 |
$100K |
| T4541 |
Large disposable underpad |
2,608 |
2,509 |
$93K |
| B4150 |
Ef complet w/intact nutrient |
1,136 |
712 |
$92K |
| A4351 |
Straight tip urine catheter |
806 |
729 |
$90K |
| E0604 |
Hosp grade elec breast pump |
2,094 |
1,856 |
$82K |
| T4525 |
Adult size pull-on sm |
919 |
882 |
$78K |
| B4155 |
Ef incomplete/modular |
1,811 |
1,465 |
$73K |
| B4158 |
Ef ped complete intact nut |
476 |
354 |
$56K |
| T4529 |
Ped size brief/diaper sm/med |
460 |
441 |
$32K |
| K0001 |
Standard wheelchair |
680 |
647 |
$32K |
| B4103 |
Ef ped fluid and electrolyte |
593 |
334 |
$30K |
| J3490 |
Drugs unclassified injection |
398 |
80 |
$27K |
| B4162 |
Ef ped specmetabolic inherit |
134 |
87 |
$24K |
| A7000 |
Disposable canister for pump |
1,127 |
988 |
$21K |
| A4221 |
Supp non-insulin inf cath/wk |
515 |
325 |
$21K |
| A4927 |
Non-sterile gloves |
2,078 |
1,978 |
$19K |
| T1001 |
Nursing assessment/evaluatn |
1,499 |
1,417 |
$19K |
| J1650 |
Inj enoxaparin sodium |
1,119 |
314 |
$19K |
| A4670 |
Automatic bp monitor, dial |
426 |
417 |
$18K |
| A4352 |
Coude tip urinary catheter |
180 |
172 |
$18K |
| E0135 |
Walker folding adjust/fixed |
312 |
302 |
$14K |
| S9542 |
Ht inj noc per diem |
131 |
55 |
$12K |
| A4628 |
Oropharyngeal suction cath |
1,249 |
974 |
$11K |
| T4531 |
Ped size pull-on sm/med |
134 |
107 |
$9K |
| T4521 |
Adult size brief/diaper sm |
82 |
78 |
$9K |
| A7005 |
Nondisposable nebulizer set |
692 |
517 |
$8K |
| A6446 |
Conform band s w>=3" <5"/yd |
177 |
127 |
$5K |
| A7003 |
Nebulizer administration set |
1,908 |
1,252 |
$4K |
| S9562 |
Ht inj palivizumab/ab diem |
271 |
251 |
$4K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
43 |
39 |
$3K |
| E0114 |
Crutch underarm pair no wood |
113 |
109 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
1,751 |
1,418 |
$3K |
| A4322 |
Irrigation syringe |
612 |
453 |
$2K |
| A4333 |
Urinary cath anchor device |
180 |
162 |
$2K |
| A4624 |
Tracheal suction tube |
42 |
38 |
$2K |
| A4402 |
Lubricant per ounce |
884 |
823 |
$2K |
| A7002 |
Tubing used w suction pump |
159 |
154 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
418 |
321 |
$2K |
| E0248 |
Hdtrans bench w/wo comm open |
12 |
12 |
$972.00 |
| 96372 |
|
109 |
103 |
$951.93 |
| A6212 |
Foam drg <=16 sq in w/border |
17 |
12 |
$784.50 |
| E0202 |
Phototherapy light w/ photom |
17 |
12 |
$764.03 |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
39 |
38 |
$762.50 |
| E1399 |
Durable medical equipment mi |
12 |
12 |
$730.78 |
| J0171 |
Adrenalin epinephrine inject |
77 |
75 |
$646.26 |
| B4082 |
Enteral ng tubing w/o stylet |
37 |
24 |
$619.47 |
| A4398 |
Ostomy irrigation bag |
185 |
131 |
$587.20 |
| A6216 |
Non-sterile gauze<=16 sq in |
207 |
185 |
$451.96 |
| A4450 |
Non-waterproof tape |
155 |
143 |
$190.34 |
| A4369 |
Skin barrier liquid per oz |
15 |
14 |
$50.05 |
| A4216 |
Sterile water/saline, 10 ml |
33 |
13 |
$14.67 |
| A9999 |
Dme supply or accessory, nos |
91 |
72 |
$0.00 |