| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A8003 |
Hard protect helmet custom |
1,199 |
1,114 |
$468K |
| A4627 |
Spacer bag/reservoir |
5,610 |
5,291 |
$115K |
| A7046 |
Repl water chamber, pap dev |
5,255 |
4,101 |
$58K |
| A4253 |
Blood glucose/reagent strips |
938 |
594 |
$39K |
| L2275 |
Plastic mod low ext pad/line |
269 |
201 |
$26K |
| A9999 |
Dme supply or accessory, nos |
212 |
155 |
$22K |
| E0607 |
Blood glucose monitor home |
601 |
323 |
$17K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,699 |
1,072 |
$12K |
| L8624 |
Lith ion batt cid, ear level |
114 |
87 |
$11K |
| B9998 |
Enteral supp not otherwise c |
395 |
318 |
$10K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
160 |
103 |
$10K |
| L2280 |
Molded inner boot |
44 |
32 |
$8K |
| E0114 |
Crutch underarm pair no wood |
399 |
306 |
$7K |
| A4259 |
Lancets per box |
1,062 |
611 |
$7K |
| A4322 |
Irrigation syringe |
224 |
149 |
$3K |
| V5140 |
Behind ear binaur hearing ai |
15 |
12 |
$3K |
| B4082 |
Enteral ng tubing w/o stylet |
305 |
179 |
$2K |
| A4670 |
Automatic bp monitor, dial |
294 |
263 |
$2K |
| L2820 |
Soft interface below knee se |
36 |
25 |
$2K |
| L3221 |
Orthopedic mens shoes dpth i |
26 |
15 |
$1K |
| A4213 |
20+ cc syringe only |
126 |
95 |
$1K |
| V5060 |
Behind ear hearing aid |
17 |
17 |
$1K |
| A7521 |
Trach/laryn tube cuffed |
19 |
15 |
$687.23 |
| A6250 |
Skin seal protect moisturizr |
408 |
306 |
$651.93 |
| E0480 |
Percussor elect/pneum home m |
1,146 |
828 |
$565.86 |
| V5267 |
Hearing aid sup/access/dev |
42 |
38 |
$393.94 |
| A7526 |
Tracheostomy tube collar |
19 |
13 |
$292.00 |
| B4035 |
Enteral feed supp pump per d |
110 |
84 |
$236.89 |
| A6219 |
Gauze <= 16 sq in w/border |
35 |
14 |
$175.56 |
| B4088 |
Gastro/jejuno tube, low-pro |
128 |
110 |
$46.04 |
| A6448 |
Lt compres band <3"/yd |
12 |
12 |
$19.84 |
| A7015 |
Aerosol mask used w nebulize |
2,929 |
2,700 |
$4.19 |
| A4245 |
Alcohol wipes per box |
365 |
273 |
$0.00 |
| A7005 |
Nondisposable nebulizer set |
668 |
594 |
$0.00 |
| A4211 |
Supp for self-adm injections |
558 |
428 |
$0.00 |
| A7003 |
Nebulizer administration set |
178 |
166 |
$0.00 |
| B4081 |
Enteral ng tubing w/ stylet |
38 |
26 |
$0.00 |
| A6402 |
Sterile gauze <= 16 sq in |
174 |
124 |
$0.00 |
| V5266 |
Battery for hearing device |
193 |
154 |
$0.00 |
| A4550 |
Surgical trays |
14 |
12 |
$0.00 |
| A4461 |
Surgicl dress hold non-reuse |
284 |
211 |
$0.00 |
| A9276 |
Disposable sensor, cgm sys |
221 |
184 |
$0.00 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
167 |
109 |
$0.00 |
| A7016 |
Nebulizer dome & mouthpiece |
78 |
68 |
$0.00 |
| A6224 |
Gauze > 48 in no w/sal w/o b |
185 |
116 |
$0.00 |
| A4252 |
Blood ketone test or strip |
103 |
80 |
$0.00 |
| E1399 |
Durable medical equipment mi |
90 |
63 |
$0.00 |
| A4657 |
Syringe w/wo needle |
78 |
52 |
$0.00 |
| A4301 |
Implantable access syst perc |
65 |
50 |
$0.00 |