| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home vent invasive interface |
7,631 |
6,650 |
$4.08M |
| B4035 |
Enteral feed supp pump per d |
21,284 |
17,048 |
$4.03M |
| B4161 |
Ef ped hydrolyzed/amino acid |
4,826 |
4,410 |
$3.13M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
10,385 |
8,776 |
$2.39M |
| E1390 |
Oxygen concentrator |
23,767 |
22,949 |
$2.12M |
| B9998 |
Enteral supp not otherwise c |
29,617 |
19,849 |
$1.85M |
| E0466 |
Home vent non-invasive inter |
3,313 |
3,166 |
$1.72M |
| A4606 |
Oxygen probe used w oximeter |
19,819 |
14,857 |
$1.58M |
| E0482 |
Cough stimulating device |
8,152 |
7,876 |
$1.50M |
| A4353 |
Intermittent urinary cath |
2,146 |
1,894 |
$1.07M |
| B4149 |
Ef blenderized foods |
2,989 |
2,560 |
$951K |
| A4554 |
Disposable underpads |
25,764 |
24,701 |
$947K |
| E0445 |
Oximeter non-invasive |
7,526 |
7,174 |
$945K |
| B4153 |
Ef hydrolyzed/amino acids |
1,014 |
972 |
$820K |
| B4150 |
Ef complet w/intact nutrient |
3,995 |
3,631 |
$814K |
| T4532 |
Ped size pull-on lg |
7,026 |
6,505 |
$811K |
| A4605 |
Trach suction cath close sys |
5,262 |
3,704 |
$653K |
| A4624 |
Tracheal suction tube |
7,000 |
6,495 |
$610K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,992 |
2,683 |
$606K |
| A7000 |
Disposable canister for pump |
22,814 |
17,957 |
$587K |
| E0471 |
Rad w/backup non inv intrfc |
2,187 |
2,095 |
$539K |
| A4629 |
Tracheostomy care kit |
8,465 |
7,639 |
$527K |
| B9002 |
Enter nutr inf pump any type |
5,287 |
5,139 |
$496K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
2,487 |
1,676 |
$440K |
| E0431 |
Portable gaseous 02 |
23,013 |
22,277 |
$361K |
| B4154 |
Ef spec metabolic noninherit |
994 |
930 |
$354K |
| B4155 |
Ef incomplete/modular |
2,414 |
2,231 |
$345K |
| B4034 |
Enter feed supkit syr by day |
4,420 |
3,817 |
$296K |
| T4533 |
Youth size brief/diaper |
3,493 |
3,261 |
$292K |
| T4526 |
Adult size pull-on med |
2,559 |
2,488 |
$280K |
| E0483 |
Hi freq chest wall oscil sys |
505 |
493 |
$272K |
| T4522 |
Adult size brief/diaper med |
2,915 |
2,769 |
$258K |
| A7002 |
Tubing used w suction pump |
19,402 |
18,535 |
$258K |
| B4158 |
Ef ped complete intact nut |
1,245 |
1,165 |
$240K |
| A7526 |
Tracheostomy tube collar |
11,202 |
8,985 |
$228K |
| K0001 |
Standard wheelchair |
7,126 |
6,939 |
$218K |
| E1236 |
Folding ped wc adjustable |
1,350 |
1,312 |
$215K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,011 |
1,797 |
$209K |
| A6212 |
Foam drg <=16 sq in w/border |
1,365 |
1,120 |
$208K |
| T4531 |
Ped size pull-on sm/med |
2,161 |
2,013 |
$195K |
| A7520 |
Trach/laryn tube non-cuffed |
5,266 |
4,791 |
$179K |
| T4527 |
Adult size pull-on lg |
1,422 |
1,347 |
$169K |
| T4523 |
Adult size brief/diaper lg |
1,697 |
1,607 |
$158K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,114 |
2,035 |
$154K |
| E0470 |
Rad w/o backup non-inv intfc |
1,162 |
1,123 |
$152K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
2,720 |
2,602 |
$152K |
| E0600 |
Suction pump portab hom modl |
1,248 |
1,146 |
$131K |
| A4335 |
Incontinence supply |
28,926 |
27,613 |
$124K |
| E0601 |
Cont airway pressure device |
3,192 |
3,057 |
$124K |
| T4521 |
Adult size brief/diaper sm |
1,543 |
1,400 |
$122K |
| B4100 |
Food thickener oral |
531 |
483 |
$120K |
| A7521 |
Trach/laryn tube cuffed |
2,619 |
2,345 |
$114K |
| B4104 |
Additive for enteral formula |
1,740 |
1,615 |
$113K |
| A4216 |
Sterile water/saline, 10 ml |
12,957 |
9,042 |
$106K |
| A4322 |
Irrigation syringe |
17,395 |
15,999 |
$103K |
| T4528 |
Adult size pull-on xl |
692 |
682 |
$102K |
| T4524 |
Adult size brief/diaper xl |
844 |
813 |
$100K |
| K0195 |
Elevating whlchair leg rests |
9,136 |
8,877 |
$95K |
| T1999 |
Noc retail items andsupplies |
35,888 |
15,906 |
$95K |
| A6402 |
Sterile gauze <= 16 sq in |
17,162 |
15,409 |
$93K |
| A4623 |
Tracheostomy inner cannula |
2,046 |
1,736 |
$84K |
| E0277 |
Powered pres-redu air mattrs |
324 |
300 |
$82K |
| A4628 |
Oropharyngeal suction cath |
19,760 |
18,346 |
$78K |
| A7034 |
Nasal application device |
1,538 |
1,471 |
$75K |
| A4351 |
Straight tip urine catheter |
654 |
539 |
$74K |
| T4530 |
Ped size brief/diaper lg |
1,119 |
1,010 |
$71K |
| E0481 |
Intrpulmnry percuss vent sys |
148 |
148 |
$65K |
| B4103 |
Ef ped fluid and electrolyte |
971 |
807 |
$63K |
| A7030 |
Cpap full face mask |
725 |
694 |
$60K |
| T4535 |
Disposable liner/shield/pad |
1,497 |
1,364 |
$54K |
| A7032 |
Replacement nasal cushion |
1,678 |
1,583 |
$52K |
| A9279 |
Monitoring feature/devicenoc |
354 |
342 |
$49K |
| E0630 |
Patient lift hydraulic |
927 |
882 |
$44K |
| A6257 |
Transparent film <= 16 sq in |
2,792 |
2,458 |
$41K |
| E0570 |
Nebulizer with compression |
601 |
563 |
$39K |
| A4927 |
Non-sterile gloves |
7,854 |
7,429 |
$36K |
| A7031 |
Replacement facemask interfa |
1,034 |
974 |
$31K |
| L1499 |
Spinal orthosis nos |
16 |
15 |
$31K |
| A4481 |
Tracheostoma filter |
5,189 |
4,078 |
$31K |
| E1399 |
Durable medical equipment mi |
40 |
24 |
$29K |
| E1225 |
Manual semi-reclining back |
1,152 |
1,116 |
$29K |
| E0971 |
Wheelchair anti-tipping devi |
564 |
537 |
$28K |
| A7037 |
Pos airway pressure tubing |
1,753 |
1,692 |
$26K |
| E0978 |
W/c acc,saf belt pelv strap |
1,092 |
1,043 |
$25K |
| A7003 |
Nebulizer administration set |
10,786 |
10,205 |
$24K |
| A9900 |
Supply/accessory/service |
773 |
650 |
$23K |
| A4402 |
Lubricant per ounce |
5,830 |
5,543 |
$21K |
| A4217 |
Sterile water/saline, 500 ml |
1,314 |
1,064 |
$19K |
| A4369 |
Skin barrier liquid per oz |
791 |
765 |
$17K |
| E0562 |
Humidifier heated used w pap |
957 |
943 |
$17K |
| A7035 |
Pos airway press headgear |
936 |
915 |
$15K |
| A7046 |
Repl water chamber, pap dev |
1,317 |
1,270 |
$13K |
| A7005 |
Nondisposable nebulizer set |
864 |
818 |
$11K |
| A4357 |
Bedside drainage bag |
731 |
651 |
$11K |
| K0006 |
Heavy duty wheelchair |
148 |
144 |
$10K |
| A4483 |
Moisture exchanger |
260 |
231 |
$9K |
| E0240 |
Bath/shower chair |
64 |
56 |
$9K |
| A4452 |
Waterproof tape |
1,300 |
1,017 |
$9K |
| A7525 |
Tracheostomy mask |
4,010 |
3,723 |
$9K |
| L8501 |
Tracheostomy speaking valve |
159 |
149 |
$9K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,214 |
1,131 |
$9K |
| A7038 |
Pos airway pressure filter |
1,952 |
1,858 |
$8K |
| E0776 |
Iv pole |
210 |
204 |
$7K |
| K0003 |
Lightweight wheelchair |
170 |
164 |
$7K |
| E0565 |
Compressor air power source |
91 |
88 |
$6K |
| A4450 |
Non-waterproof tape |
3,340 |
3,035 |
$5K |
| A5120 |
Skin barrier, wipe or swab |
643 |
630 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
79 |
74 |
$4K |
| A7015 |
Aerosol mask used w nebulize |
4,309 |
4,052 |
$4K |
| A5061 |
Pouch drainable w barrier at |
38 |
36 |
$3K |
| B4036 |
Enteral feed sup kit grav by |
31 |
25 |
$3K |
| T4534 |
Youth size pull-on |
30 |
30 |
$3K |
| A4245 |
Alcohol wipes per box |
2,465 |
2,379 |
$3K |
| A4310 |
Insert tray w/o bag/cath |
44 |
38 |
$2K |
| A7013 |
Disposable compressor filter |
3,417 |
3,309 |
$2K |
| A7039 |
Filter, non disposable w pap |
323 |
310 |
$2K |
| A7007 |
Lg vol nebulizer disposable |
726 |
654 |
$2K |
| A4406 |
Pectin based ostomy paste |
165 |
164 |
$2K |
| B4082 |
Enteral ng tubing w/o stylet |
26 |
25 |
$1K |
| E0163 |
Commode chair with fixed arm |
28 |
28 |
$1K |
| A4456 |
Adhesive remover, wipes |
148 |
123 |
$1K |
| A4244 |
Alcohol or peroxide per pint |
2,010 |
1,927 |
$1K |
| K0007 |
Extra heavy duty wheelchair |
13 |
12 |
$1K |
| E0247 |
Trans bench w/wo comm open |
13 |
13 |
$877.50 |
| A4213 |
20+ cc syringe only |
187 |
174 |
$665.23 |
| A4371 |
Skin barrier powder per oz |
12 |
12 |
$41.94 |
| A9270 |
Non-covered item or service |
382 |
277 |
$0.00 |