| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
1,861 |
265 |
$77K |
| B9002 |
Enter nutr inf pump any type |
205 |
191 |
$22K |
| B4088 |
Gastro/jejuno tube, low-pro |
527 |
444 |
$13K |
| E0445 |
Oximeter non-invasive |
94 |
87 |
$11K |
| E1390 |
Oxygen concentrator |
114 |
103 |
$11K |
| B9998 |
Enteral supp not otherwise c |
342 |
145 |
$7K |
| A6197 |
Alginate drsg >16 <=48 sq in |
13 |
13 |
$7K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
91 |
50 |
$6K |
| A4213 |
20+ cc syringe only |
458 |
393 |
$4K |
| A6196 |
Alginate dressing <=16 sq in |
13 |
13 |
$3K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
13 |
13 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
114 |
99 |
$840.22 |
| E0431 |
Portable gaseous 02 |
45 |
36 |
$756.26 |
| A4450 |
Non-waterproof tape |
160 |
140 |
$358.34 |
| E1399 |
Durable medical equipment mi |
39 |
27 |
$0.00 |
| A4606 |
Oxygen probe used w oximeter |
26 |
25 |
$0.00 |