| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1726 |
Makena, 10 mg |
7,600 |
2,244 |
$6.26M |
| 90378 |
|
1,336 |
847 |
$2.56M |
| B4197 |
Parenteral sol 74-100 gm pro |
1,910 |
485 |
$1.72M |
| E1390 |
Oxygen concentrator |
26,969 |
24,956 |
$1.51M |
| B4035 |
Enteral feed supp pump per d |
11,242 |
8,044 |
$1.07M |
| E0601 |
Cont airway pressure device |
16,967 |
16,389 |
$999K |
| B4153 |
Ef hydrolyzed/amino acids |
1,646 |
1,231 |
$525K |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,558 |
1,155 |
$487K |
| E0431 |
Portable gaseous 02 |
21,866 |
20,327 |
$477K |
| A4222 |
Infusion supplies with pump |
4,243 |
1,133 |
$444K |
| E0562 |
Humidifier heated used w pap |
2,640 |
2,498 |
$413K |
| A4649 |
Surgical supplies |
23,938 |
1,193 |
$382K |
| B4224 |
Parenteral administration ki |
8,618 |
1,846 |
$353K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,676 |
2,703 |
$321K |
| E0470 |
Rad w/o backup non-inv intfc |
2,033 |
1,945 |
$278K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,005 |
1,391 |
$266K |
| A7030 |
Cpap full face mask |
3,569 |
3,336 |
$256K |
| A4223 |
Infusion supplies w/o pump |
5,146 |
1,320 |
$248K |
| B4199 |
Parenteral sol > 100gm prote |
275 |
76 |
$233K |
| A4604 |
Tubing with heating element |
5,068 |
4,743 |
$174K |
| B4150 |
Ef complet w/intact nutrient |
2,101 |
1,461 |
$161K |
| E0424 |
Stationary compressed gas 02 |
1,667 |
1,562 |
$147K |
| A7035 |
Pos airway press headgear |
5,231 |
4,943 |
$123K |
| B4220 |
Parenteral supply kit premix |
8,141 |
1,807 |
$123K |
| E0445 |
Oximeter non-invasive |
582 |
542 |
$119K |
| E0471 |
Rad w/backup non inv intrfc |
540 |
460 |
$113K |
| A7034 |
Nasal application device |
2,627 |
2,496 |
$111K |
| E0570 |
Nebulizer with compression |
4,061 |
3,769 |
$106K |
| B9002 |
Enter nutr inf pump any type |
2,120 |
1,849 |
$106K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,254 |
1,039 |
$85K |
| A4221 |
Supp non-insulin inf cath/wk |
4,187 |
1,871 |
$73K |
| B4034 |
Enter feed supkit syr by day |
1,713 |
1,363 |
$61K |
| K0738 |
Portable gas oxygen system |
2,346 |
2,207 |
$53K |
| A7031 |
Replacement facemask interfa |
1,552 |
1,426 |
$47K |
| S9560 |
Ht inj hormone diem |
1,059 |
747 |
$42K |
| S9500 |
Hit antibiotic q24h diem |
150 |
52 |
$32K |
| S9542 |
Ht inj noc per diem |
722 |
531 |
$31K |
| A7039 |
Filter, non disposable w pap |
2,897 |
2,771 |
$25K |
| A4216 |
Sterile water/saline, 10 ml |
2,007 |
1,014 |
$24K |
| A7038 |
Pos airway pressure filter |
6,284 |
5,888 |
$20K |
| S9562 |
Ht inj palivizumab/ab diem |
944 |
784 |
$18K |
| A7005 |
Nondisposable nebulizer set |
1,177 |
1,106 |
$17K |
| E1392 |
Portable oxygen concentrator |
559 |
518 |
$16K |
| J3370 |
Vancomycin hcl injection |
157 |
64 |
$11K |
| A7037 |
Pos airway pressure tubing |
479 |
452 |
$9K |
| E0600 |
Suction pump portab hom modl |
172 |
142 |
$9K |
| E0565 |
Compressor air power source |
188 |
178 |
$8K |
| E0781 |
External ambulatory infus pu |
223 |
67 |
$6K |
| A7046 |
Repl water chamber, pap dev |
1,209 |
1,124 |
$5K |
| A7032 |
Replacement nasal cushion |
238 |
218 |
$4K |
| A7033 |
Replacement nasal pillows |
113 |
103 |
$2K |
| A7000 |
Disposable canister for pump |
60 |
50 |
$808.88 |
| A7526 |
Tracheostomy tube collar |
27 |
24 |
$621.01 |
| B4185 |
Pn soln nos 10 grams lipids |
34 |
12 |
$494.14 |
| A7015 |
Aerosol mask used w nebulize |
214 |
204 |
$277.35 |
| A7002 |
Tubing used w suction pump |
39 |
36 |
$269.59 |
| A7003 |
Nebulizer administration set |
288 |
238 |
$253.59 |
| B4155 |
Ef incomplete/modular |
14 |
12 |
$248.50 |