| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
28,385 |
27,212 |
$2.15M |
| B4161 |
Ef ped hydrolyzed/amino acid |
2,909 |
2,610 |
$1.54M |
| A9276 |
Disposable sensor, cgm sys |
5,100 |
4,491 |
$1.51M |
| K0553 |
Ther cgm supply allowance |
7,259 |
6,960 |
$1.03M |
| E0601 |
Cont airway pressure device |
13,997 |
13,666 |
$851K |
| A9277 |
External transmitter, cgm |
1,741 |
1,666 |
$739K |
| B4035 |
Enteral feed supp pump per d |
4,661 |
4,240 |
$692K |
| E0570 |
Nebulizer with compression |
12,959 |
12,428 |
$606K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,831 |
3,327 |
$566K |
| B4150 |
Ef complet w/intact nutrient |
5,431 |
4,797 |
$505K |
| A7030 |
Cpap full face mask |
6,473 |
6,221 |
$459K |
| E0470 |
Rad w/o backup non-inv intfc |
3,191 |
3,050 |
$433K |
| K0738 |
Portable gas oxygen system |
10,664 |
10,306 |
$406K |
| T4528 |
Adult size pull-on xl |
4,296 |
4,070 |
$391K |
| T4527 |
Adult size pull-on lg |
4,568 |
4,300 |
$382K |
| E0562 |
Humidifier heated used w pap |
2,640 |
2,536 |
$342K |
| E0431 |
Portable gaseous 02 |
12,058 |
11,703 |
$336K |
| B9998 |
Enteral supp not otherwise c |
3,827 |
3,088 |
$328K |
| K0001 |
Standard wheelchair |
10,218 |
9,700 |
$327K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,325 |
2,008 |
$321K |
| T2029 |
Special med equip, noswaiver |
3,039 |
2,893 |
$284K |
| E0260 |
Hosp bed semi-electr w/ matt |
5,014 |
4,511 |
$258K |
| A4604 |
Tubing with heating element |
7,927 |
7,611 |
$258K |
| T4535 |
Disposable liner/shield/pad |
5,770 |
5,428 |
$251K |
| T4526 |
Adult size pull-on med |
3,213 |
2,997 |
$248K |
| B4154 |
Ef spec metabolic noninherit |
1,236 |
1,099 |
$224K |
| A7035 |
Pos airway press headgear |
8,154 |
7,874 |
$180K |
| A7034 |
Nasal application device |
4,117 |
3,986 |
$176K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,711 |
1,625 |
$168K |
| E0603 |
Electric breast pump |
857 |
848 |
$152K |
| E0143 |
Walker folding wheeled w/o s |
3,724 |
3,578 |
$152K |
| T4541 |
Large disposable underpad |
4,161 |
4,009 |
$151K |
| T4523 |
Adult size brief/diaper lg |
1,542 |
1,397 |
$143K |
| A7005 |
Nondisposable nebulizer set |
7,451 |
7,180 |
$131K |
| A4670 |
Automatic bp monitor, dial |
2,928 |
2,850 |
$129K |
| E0445 |
Oximeter non-invasive |
628 |
596 |
$128K |
| T4522 |
Adult size brief/diaper med |
1,389 |
1,271 |
$127K |
| B9002 |
Enter nutr inf pump any type |
1,868 |
1,801 |
$114K |
| A9278 |
External receiver, cgm sys |
252 |
250 |
$108K |
| L3908 |
Who cock-up nonmolde pre ots |
2,799 |
1,968 |
$107K |
| A7031 |
Replacement facemask interfa |
4,701 |
4,403 |
$105K |
| B4034 |
Enter feed supkit syr by day |
1,775 |
1,626 |
$102K |
| T4542 |
Small disposable underpad |
2,970 |
2,741 |
$99K |
| T4534 |
Youth size pull-on |
1,129 |
1,056 |
$98K |
| B4158 |
Ef ped complete intact nut |
443 |
404 |
$94K |
| A4351 |
Straight tip urine catheter |
1,321 |
1,202 |
$85K |
| A4927 |
Non-sterile gloves |
6,959 |
6,541 |
$82K |
| T4524 |
Adult size brief/diaper xl |
754 |
689 |
$77K |
| T4525 |
Adult size pull-on sm |
943 |
867 |
$76K |
| E0245 |
Tub stool or bench |
1,893 |
1,786 |
$71K |
| A7037 |
Pos airway pressure tubing |
3,330 |
3,200 |
$64K |
| K0006 |
Heavy duty wheelchair |
723 |
680 |
$61K |
| E0630 |
Patient lift hydraulic |
1,136 |
1,054 |
$58K |
| A7032 |
Replacement nasal cushion |
2,438 |
2,290 |
$57K |
| K0007 |
Extra heavy duty wheelchair |
368 |
336 |
$56K |
| T4530 |
Ped size brief/diaper lg |
641 |
595 |
$54K |
| L1820 |
Ko elas w/ condyle pads & jo |
651 |
587 |
$52K |
| E0114 |
Crutch underarm pair no wood |
2,100 |
2,078 |
$49K |
| A7038 |
Pos airway pressure filter |
14,156 |
12,817 |
$49K |
| A6530 |
Compression stocking bk18-30 |
998 |
839 |
$47K |
| K0554 |
Ther cgm receiver/monitor |
291 |
265 |
$46K |
| E1392 |
Portable oxygen concentrator |
1,557 |
1,471 |
$45K |
| A5061 |
Pouch drainable w barrier at |
987 |
896 |
$41K |
| K0195 |
Elevating whlchair leg rests |
2,828 |
2,715 |
$39K |
| L4386 |
Non-pneum walk boot pre cst |
410 |
397 |
$38K |
| A7033 |
Replacement nasal pillows |
1,490 |
1,411 |
$37K |
| B4149 |
Ef blenderized foods |
178 |
107 |
$34K |
| E0255 |
Hospital bed var ht w/ mattr |
863 |
839 |
$31K |
| A5500 |
Diab shoe for density insert |
598 |
500 |
$31K |
| A7046 |
Repl water chamber, pap dev |
4,241 |
4,083 |
$28K |
| E0250 |
Hosp bed fixed ht w/ mattres |
1,959 |
1,883 |
$28K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,031 |
838 |
$27K |
| E0244 |
Toilet seat raised |
653 |
605 |
$26K |
| E0149 |
Heavy duty wheeled walker |
791 |
740 |
$25K |
| E0248 |
Hdtrans bench w/wo comm open |
306 |
289 |
$25K |
| A5513 |
Multi den insert custom mold |
425 |
313 |
$24K |
| A6446 |
Conform band s w>=3" <5"/yd |
982 |
812 |
$22K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
378 |
346 |
$22K |
| E0600 |
Suction pump portab hom modl |
280 |
257 |
$21K |
| L3807 |
Whfo w/o joints pre cst |
146 |
137 |
$19K |
| A4385 |
Ost skn barrier sld ext wear |
764 |
643 |
$19K |
| T4543 |
Adult disp brief/diap abv xl |
135 |
115 |
$15K |
| E0156 |
Walker seat attachment |
1,374 |
1,322 |
$14K |
| A4623 |
Tracheostomy inner cannula |
218 |
196 |
$12K |
| E0163 |
Commode chair with fixed arm |
324 |
282 |
$11K |
| B4155 |
Ef incomplete/modular |
175 |
159 |
$11K |
| A7003 |
Nebulizer administration set |
4,609 |
4,408 |
$10K |
| A7039 |
Filter, non disposable w pap |
1,151 |
1,096 |
$9K |
| E0776 |
Iv pole |
489 |
469 |
$9K |
| T1999 |
Noc retail items andsupplies |
409 |
372 |
$9K |
| E0303 |
Hosp bed hvy dty xtra wide |
84 |
74 |
$8K |
| A5063 |
Drain ostomy pouch w/flange |
391 |
337 |
$7K |
| A6402 |
Sterile gauze <= 16 sq in |
919 |
779 |
$7K |
| A6216 |
Non-sterile gauze<=16 sq in |
828 |
749 |
$7K |
| A5120 |
Skin barrier, wipe or swab |
1,093 |
993 |
$7K |
| A7036 |
Pos airway press chinstrap |
709 |
694 |
$7K |
| A7000 |
Disposable canister for pump |
745 |
678 |
$7K |
| A4357 |
Bedside drainage bag |
983 |
892 |
$6K |
| A4362 |
Solid skin barrier |
122 |
115 |
$6K |
| A7015 |
Aerosol mask used w nebulize |
3,241 |
3,073 |
$5K |
| T4537 |
Reusable underpad bed size |
130 |
121 |
$5K |
| B4100 |
Food thickener oral |
26 |
26 |
$5K |
| A4216 |
Sterile water/saline, 10 ml |
580 |
494 |
$5K |
| A4452 |
Waterproof tape |
194 |
167 |
$4K |
| A4450 |
Non-waterproof tape |
736 |
652 |
$4K |
| A4406 |
Pectin based ostomy paste |
642 |
574 |
$4K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
27 |
27 |
$4K |
| E0100 |
Cane adjust/fixed with tip |
451 |
434 |
$4K |
| E0565 |
Compressor air power source |
66 |
66 |
$3K |
| A7002 |
Tubing used w suction pump |
546 |
377 |
$3K |
| T4521 |
Adult size brief/diaper sm |
31 |
24 |
$3K |
| A6212 |
Foam drg <=16 sq in w/border |
28 |
27 |
$3K |
| E0471 |
Rad w/backup non inv intrfc |
12 |
12 |
$2K |
| L4387 |
Non-pneum walk boot pre ots |
29 |
28 |
$2K |
| A7526 |
Tracheostomy tube collar |
117 |
109 |
$2K |
| A4402 |
Lubricant per ounce |
785 |
728 |
$2K |
| K0053 |
Elevate footrest articulate |
25 |
25 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
142 |
88 |
$2K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
68 |
55 |
$2K |
| A4624 |
Tracheal suction tube |
42 |
37 |
$2K |
| T4533 |
Youth size brief/diaper |
21 |
16 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
149 |
138 |
$1K |
| A4628 |
Oropharyngeal suction cath |
176 |
164 |
$1K |
| L1810 |
Ko elastic with joints |
16 |
15 |
$1K |
| A4253 |
Blood glucose/reagent strips |
159 |
146 |
$1K |
| L4350 |
Ankle control ortho pre ots |
13 |
13 |
$815.60 |
| E0105 |
Cane adjust/fixed quad/3 pro |
27 |
27 |
$763.45 |
| E2601 |
Gen w/c cushion wdth < 22 in |
12 |
12 |
$673.49 |
| A4629 |
Tracheostomy care kit |
14 |
12 |
$665.34 |
| A4407 |
Ext wear ost skn barr <=4sq" |
13 |
12 |
$542.03 |
| A4349 |
Disposable male external cat |
14 |
12 |
$395.31 |
| A6449 |
Lt compres band >=3" <5"/yd |
12 |
12 |
$349.85 |
| A4310 |
Insert tray w/o bag/cath |
197 |
65 |
$311.90 |
| A4338 |
Indwelling catheter latex |
25 |
24 |
$142.54 |
| A4259 |
Lancets per box |
26 |
24 |
$42.70 |