| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
3,101 |
3,061 |
$2.74M |
| B4035 |
Enteral feed supp pump per d |
8,600 |
8,532 |
$2.68M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,335 |
3,309 |
$1.23M |
| E0465 |
Home vent invasive interface |
1,219 |
1,188 |
$1.09M |
| B9998 |
Enteral supp not otherwise c |
11,738 |
9,858 |
$1.01M |
| E1390 |
Oxygen concentrator |
5,488 |
5,466 |
$715K |
| B4149 |
Ef blenderized foods |
917 |
909 |
$466K |
| A4606 |
Oxygen probe used w oximeter |
8,068 |
3,423 |
$422K |
| E0445 |
Oximeter non-invasive |
1,981 |
1,963 |
$341K |
| E0482 |
Cough stimulating device |
1,014 |
1,005 |
$269K |
| B9002 |
Enter nutr inf pump any type |
2,771 |
2,725 |
$268K |
| A4353 |
Intermittent urinary cath |
276 |
242 |
$250K |
| A4629 |
Tracheostomy care kit |
2,018 |
1,940 |
$246K |
| A4605 |
Trach suction cath close sys |
911 |
814 |
$163K |
| E0431 |
Portable gaseous 02 |
6,502 |
6,418 |
$150K |
| A4554 |
Disposable underpads |
5,294 |
5,105 |
$141K |
| A7000 |
Disposable canister for pump |
4,634 |
4,584 |
$139K |
| A4624 |
Tracheal suction tube |
765 |
748 |
$133K |
| T4530 |
Ped size brief/diaper lg |
1,215 |
1,165 |
$120K |
| T4533 |
Youth size brief/diaper |
797 |
788 |
$87K |
| A4322 |
Irrigation syringe |
9,329 |
9,163 |
$86K |
| A7526 |
Tracheostomy tube collar |
2,213 |
2,158 |
$83K |
| T4522 |
Adult size brief/diaper med |
757 |
752 |
$82K |
| A7520 |
Trach/laryn tube non-cuffed |
1,677 |
1,655 |
$78K |
| A6216 |
Non-sterile gauze<=16 sq in |
9,955 |
9,041 |
$74K |
| A4927 |
Non-sterile gloves |
8,888 |
8,838 |
$62K |
| A4483 |
Moisture exchanger |
549 |
488 |
$58K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
471 |
458 |
$56K |
| A7002 |
Tubing used w suction pump |
4,564 |
4,537 |
$52K |
| A4216 |
Sterile water/saline, 10 ml |
1,435 |
1,405 |
$30K |
| A4628 |
Oropharyngeal suction cath |
4,340 |
4,250 |
$28K |
| A4335 |
Incontinence supply |
5,438 |
5,387 |
$27K |
| A4332 |
Lube sterile packet |
5,294 |
5,266 |
$19K |
| A4217 |
Sterile water/saline, 500 ml |
5,316 |
5,289 |
$15K |
| A4450 |
Non-waterproof tape |
9,118 |
9,077 |
$15K |
| A7003 |
Nebulizer administration set |
3,352 |
3,327 |
$13K |
| E0776 |
Iv pole |
1,561 |
1,547 |
$12K |
| A4245 |
Alcohol wipes per box |
6,725 |
6,697 |
$12K |
| T4521 |
Adult size brief/diaper sm |
91 |
85 |
$9K |
| T1999 |
Noc retail items andsupplies |
1,426 |
1,177 |
$7K |
| A4244 |
Alcohol or peroxide per pint |
7,107 |
7,080 |
$6K |
| A7525 |
Tracheostomy mask |
1,720 |
1,047 |
$4K |
| E0562 |
Humidifier heated used w pap |
276 |
265 |
$3K |
| T4523 |
Adult size brief/diaper lg |
24 |
24 |
$2K |
| L8501 |
Tracheostomy speaking valve |
13 |
13 |
$814.64 |
| A4402 |
Lubricant per ounce |
389 |
386 |
$521.16 |