| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
6,393 |
2,925 |
$3.04M |
| B4035 |
Enteral feed supp pump per d |
99,556 |
6,597 |
$1.52M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,480 |
2,387 |
$1.13M |
| E0465 |
Home vent invasive interface |
1,434 |
878 |
$500K |
| E1390 |
Oxygen concentrator |
4,491 |
3,126 |
$449K |
| B4149 |
Ef blenderized foods |
2,335 |
920 |
$246K |
| A4222 |
Infusion supplies with pump |
2,267 |
507 |
$187K |
| B4034 |
Enter feed supkit syr by day |
11,539 |
1,216 |
$161K |
| B4150 |
Ef complet w/intact nutrient |
2,466 |
1,369 |
$161K |
| B4153 |
Ef hydrolyzed/amino acids |
648 |
321 |
$156K |
| B4088 |
Gastro/jejuno tube, low-pro |
3,808 |
1,697 |
$108K |
| E0445 |
Oximeter non-invasive |
524 |
470 |
$101K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,136 |
906 |
$88K |
| E0431 |
Portable gaseous 02 |
2,925 |
2,215 |
$71K |
| A4221 |
Supp non-insulin inf cath/wk |
2,982 |
976 |
$59K |
| B4224 |
Parenteral administration ki |
705 |
88 |
$59K |
| E0601 |
Cont airway pressure device |
1,983 |
1,485 |
$51K |
| B4185 |
Pn soln nos 10 grams lipids |
628 |
82 |
$47K |
| A4606 |
Oxygen probe used w oximeter |
712 |
371 |
$44K |
| A4217 |
Sterile water/saline, 500 ml |
265 |
107 |
$41K |
| A4604 |
Tubing with heating element |
1,180 |
762 |
$32K |
| A7030 |
Cpap full face mask |
447 |
272 |
$27K |
| A7526 |
Tracheostomy tube collar |
287 |
196 |
$23K |
| B4220 |
Parenteral supply kit premix |
700 |
88 |
$19K |
| B4155 |
Ef incomplete/modular |
501 |
340 |
$18K |
| S9342 |
Hit enteral pump diem |
2,570 |
222 |
$16K |
| A4624 |
Tracheal suction tube |
214 |
103 |
$12K |
| E0470 |
Rad w/o backup non-inv intfc |
186 |
132 |
$11K |
| A7000 |
Disposable canister for pump |
1,124 |
703 |
$11K |
| E0562 |
Humidifier heated used w pap |
528 |
368 |
$10K |
| B4036 |
Enteral feed sup kit grav by |
196 |
60 |
$7K |
| A7038 |
Pos airway pressure filter |
1,410 |
875 |
$7K |
| E1392 |
Portable oxygen concentrator |
93 |
76 |
$6K |
| A7035 |
Pos airway press headgear |
412 |
297 |
$6K |
| A7031 |
Replacement facemask interfa |
183 |
94 |
$6K |
| E0600 |
Suction pump portab hom modl |
235 |
171 |
$5K |
| A7046 |
Repl water chamber, pap dev |
474 |
287 |
$4K |
| A7002 |
Tubing used w suction pump |
873 |
563 |
$3K |
| T1030 |
Rn home care per diem |
37 |
24 |
$3K |
| A4628 |
Oropharyngeal suction cath |
238 |
167 |
$3K |
| A7034 |
Nasal application device |
67 |
51 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
179 |
72 |
$2K |
| A7003 |
Nebulizer administration set |
182 |
118 |
$788.78 |
| A4605 |
Trach suction cath close sys |
17 |
13 |
$612.31 |
| E0570 |
Nebulizer with compression |
39 |
37 |
$340.68 |