| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90378 |
|
242 |
231 |
$946K |
| S9342 |
Hit enteral pump diem |
1,456 |
1,249 |
$666K |
| E0601 |
Cont airway pressure device |
3,592 |
3,579 |
$200K |
| E0603 |
Electric breast pump |
725 |
725 |
$128K |
| B4161 |
Ef ped hydrolyzed/amino acid |
148 |
106 |
$86K |
| E0143 |
Walker folding wheeled w/o s |
1,157 |
1,157 |
$83K |
| E0562 |
Humidifier heated used w pap |
3,487 |
3,483 |
$58K |
| K0553 |
Ther cgm supply allowance |
145 |
139 |
$34K |
| K0001 |
Standard wheelchair |
1,201 |
1,200 |
$32K |
| A4239 |
Non-adju cgm supply allow |
155 |
153 |
$30K |
| S9500 |
Hit antibiotic q24h diem |
67 |
27 |
$25K |
| 99601 |
|
211 |
133 |
$19K |
| A7034 |
Nasal application device |
221 |
221 |
$14K |
| A7035 |
Pos airway press headgear |
676 |
676 |
$14K |
| S9338 |
Hit immunotherapy diem |
161 |
69 |
$11K |
| E0990 |
Wheelchair elevating leg res |
580 |
580 |
$10K |
| S5502 |
Hit interim cath care |
82 |
56 |
$8K |
| A4604 |
Tubing with heating element |
104 |
104 |
$5K |
| 99602 |
Nursing care in home rn |
53 |
37 |
$4K |
| E0163 |
Commode chair with fixed arm |
51 |
51 |
$4K |
| A7038 |
Pos airway pressure filter |
666 |
652 |
$3K |
| B4152 |
Ef calorie dense>/=1.5kcal |
17 |
12 |
$3K |
| S9562 |
Ht inj palivizumab/ab diem |
288 |
271 |
$2K |
| A7032 |
Replacement nasal cushion |
38 |
37 |
$2K |
| E0247 |
Trans bench w/wo comm open |
14 |
14 |
$1K |
| A7031 |
Replacement facemask interfa |
24 |
24 |
$1K |
| E0114 |
Crutch underarm pair no wood |
13 |
13 |
$437.06 |
| B4035 |
Enteral feed supp pump per d |
13 |
13 |
$436.96 |
| J0171 |
Adrenalin epinephrine inject |
29 |
28 |
$235.10 |
| S9542 |
Ht inj noc per diem |
19 |
16 |
$184.00 |