| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Noc retail items andsupplies |
12,273 |
11,238 |
$437K |
| T4535 |
Disposable liner/shield/pad |
5,423 |
4,980 |
$321K |
| A9999 |
Dme supply or accessory, nos |
11,706 |
6,182 |
$297K |
| T4527 |
Adult size pull-on lg |
2,027 |
1,884 |
$274K |
| T4526 |
Adult size pull-on med |
2,067 |
1,903 |
$253K |
| T4534 |
Youth size pull-on |
1,495 |
1,313 |
$199K |
| T4541 |
Large disposable underpad |
4,417 |
4,103 |
$198K |
| E1390 |
Oxygen concentrator |
2,739 |
2,226 |
$197K |
| B4150 |
Ef complet w/intact nutrient |
1,316 |
1,109 |
$177K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,133 |
913 |
$147K |
| T4528 |
Adult size pull-on xl |
1,127 |
1,056 |
$145K |
| T4537 |
Reusable underpad bed size |
3,243 |
2,929 |
$142K |
| B9998 |
Enteral supp not otherwise c |
1,113 |
431 |
$124K |
| A4927 |
Non-sterile gloves |
6,435 |
5,713 |
$113K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
619 |
456 |
$100K |
| S5161 |
Emer rspns sys serv permonth |
2,697 |
2,058 |
$86K |
| A6250 |
Skin seal protect moisturizr |
7,903 |
4,034 |
$76K |
| E1392 |
Portable oxygen concentrator |
1,909 |
1,537 |
$53K |
| B4088 |
Gastro/jejuno tube, low-pro |
255 |
198 |
$48K |
| T4543 |
Adult disp brief/diap abv xl |
81 |
74 |
$46K |
| T4523 |
Adult size brief/diaper lg |
358 |
315 |
$43K |
| T4530 |
Ped size brief/diaper lg |
330 |
275 |
$33K |
| A4335 |
Incontinence supply |
2,273 |
1,331 |
$17K |
| A4322 |
Irrigation syringe |
328 |
251 |
$14K |
| T4522 |
Adult size brief/diaper med |
106 |
91 |
$12K |
| T4524 |
Adult size brief/diaper xl |
42 |
39 |
$7K |
| A6402 |
Sterile gauze <= 16 sq in |
412 |
312 |
$5K |
| A4213 |
20+ cc syringe only |
117 |
101 |
$4K |
| B4034 |
Enter feed supkit syr by day |
49 |
36 |
$4K |
| A7038 |
Pos airway pressure filter |
665 |
628 |
$2K |
| A4604 |
Tubing with heating element |
53 |
53 |
$2K |
| A4357 |
Bedside drainage bag |
176 |
129 |
$2K |
| E0601 |
Cont airway pressure device |
18 |
15 |
$2K |
| E0431 |
Portable gaseous 02 |
59 |
40 |
$495.85 |
| A4657 |
Syringe w/wo needle |
16 |
12 |
$397.63 |
| A7031 |
Replacement facemask interfa |
13 |
13 |
$397.07 |
| A9901 |
Delivery/set up/dispensing |
229 |
186 |
$369.76 |
| A7000 |
Disposable canister for pump |
30 |
26 |
$361.44 |
| A7002 |
Tubing used w suction pump |
64 |
51 |
$349.81 |
| E0570 |
Nebulizer with compression |
12 |
12 |
$303.63 |
| A7035 |
Pos airway press headgear |
13 |
12 |
$259.76 |
| A4628 |
Oropharyngeal suction cath |
20 |
14 |
$236.94 |
| A4358 |
Urinary leg or abdomen bag |
59 |
36 |
$186.79 |