| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
3,962 |
2,959 |
$4.32M |
| B4035 |
Enteral feed supp pump per d |
6,185 |
5,646 |
$1.21M |
| E0465 |
Home vent invasive interface |
1,604 |
1,494 |
$932K |
| B9002 |
Enter nutr inf pump any type |
10,981 |
10,643 |
$752K |
| E0445 |
Oximeter non-invasive |
9,655 |
9,030 |
$713K |
| B4149 |
Ef blenderized foods |
1,576 |
1,407 |
$572K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,575 |
2,367 |
$486K |
| A4624 |
Tracheal suction tube |
4,960 |
3,532 |
$471K |
| E1390 |
Oxygen concentrator |
3,213 |
2,978 |
$429K |
| E0424 |
Stationary compressed gas 02 |
2,458 |
2,283 |
$401K |
| B4087 |
Gastro/jejuno tube, std |
16,754 |
6,884 |
$344K |
| B4088 |
Gastro/jejuno tube, low-pro |
2,813 |
2,625 |
$247K |
| E0439 |
Stationary liquid 02 |
1,403 |
1,274 |
$220K |
| B4153 |
Ef hydrolyzed/amino acids |
278 |
264 |
$213K |
| T4534 |
Youth size pull-on |
2,059 |
1,827 |
$211K |
| E0431 |
Portable gaseous 02 |
7,777 |
7,236 |
$208K |
| E0466 |
Home vent non-invasive inter |
331 |
295 |
$184K |
| B9998 |
Enteral supp not otherwise c |
612 |
475 |
$164K |
| A7521 |
Trach/laryn tube cuffed |
654 |
601 |
$142K |
| T4522 |
Adult size brief/diaper med |
1,437 |
1,329 |
$134K |
| E0471 |
Rad w/backup non inv intrfc |
427 |
390 |
$129K |
| A4554 |
Disposable underpads |
3,232 |
3,083 |
$128K |
| T4530 |
Ped size brief/diaper lg |
1,553 |
1,380 |
$116K |
| E0601 |
Cont airway pressure device |
1,676 |
1,614 |
$109K |
| A9900 |
Supply/accessory/service |
975 |
647 |
$83K |
| A7508 |
Housing & integrated adhesiv |
1,737 |
1,562 |
$82K |
| B4150 |
Ef complet w/intact nutrient |
463 |
423 |
$78K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
194 |
182 |
$73K |
| T4521 |
Adult size brief/diaper sm |
915 |
806 |
$71K |
| A4213 |
20+ cc syringe only |
3,850 |
3,543 |
$63K |
| A6402 |
Sterile gauze <= 16 sq in |
4,190 |
3,850 |
$59K |
| E1060 |
Wheelchair detachable arms |
855 |
807 |
$58K |
| E0600 |
Suction pump portab hom modl |
2,451 |
2,276 |
$58K |
| A4927 |
Non-sterile gloves |
5,916 |
5,498 |
$58K |
| A4629 |
Tracheostomy care kit |
712 |
662 |
$53K |
| K0001 |
Standard wheelchair |
1,735 |
1,675 |
$52K |
| B4152 |
Ef calorie dense>/=1.5kcal |
316 |
291 |
$48K |
| A4209 |
5+ cc sterile syringe&needle |
5,069 |
4,517 |
$48K |
| A4450 |
Non-waterproof tape |
2,150 |
1,994 |
$41K |
| E0565 |
Compressor air power source |
1,787 |
1,670 |
$40K |
| E0570 |
Nebulizer with compression |
490 |
439 |
$38K |
| B4155 |
Ef incomplete/modular |
781 |
711 |
$36K |
| E0619 |
Apnea monitor w recorder |
321 |
268 |
$34K |
| A4452 |
Waterproof tape |
1,326 |
1,239 |
$33K |
| A7520 |
Trach/laryn tube non-cuffed |
658 |
611 |
$31K |
| A6257 |
Transparent film <= 16 sq in |
1,193 |
1,035 |
$28K |
| A7526 |
Tracheostomy tube collar |
1,964 |
1,835 |
$26K |
| A4216 |
Sterile water/saline, 10 ml |
1,033 |
962 |
$25K |
| T4523 |
Adult size brief/diaper lg |
241 |
226 |
$25K |
| A7003 |
Nebulizer administration set |
2,976 |
2,766 |
$24K |
| E0776 |
Iv pole |
1,723 |
1,646 |
$20K |
| E0550 |
Humidif extens supple w ippb |
532 |
489 |
$17K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
157 |
142 |
$16K |
| A4332 |
Lube sterile packet |
1,481 |
1,395 |
$15K |
| A6212 |
Foam drg <=16 sq in w/border |
87 |
85 |
$14K |
| K0195 |
Elevating whlchair leg rests |
1,055 |
1,025 |
$12K |
| E0562 |
Humidifier heated used w pap |
1,961 |
1,873 |
$12K |
| A4627 |
Spacer bag/reservoir |
526 |
507 |
$11K |
| A4245 |
Alcohol wipes per box |
1,409 |
1,343 |
$11K |
| A7002 |
Tubing used w suction pump |
3,471 |
3,272 |
$10K |
| A4208 |
3 cc sterile syringe&needle |
981 |
928 |
$7K |
| A4244 |
Alcohol or peroxide per pint |
2,172 |
1,977 |
$7K |
| T4525 |
Adult size pull-on sm |
74 |
67 |
$6K |
| A6216 |
Non-sterile gauze<=16 sq in |
816 |
773 |
$5K |
| A7000 |
Disposable canister for pump |
848 |
761 |
$4K |
| A7010 |
Disposable corrugated tubing |
312 |
299 |
$4K |
| T4526 |
Adult size pull-on med |
30 |
28 |
$3K |
| A7007 |
Lg vol nebulizer disposable |
344 |
332 |
$3K |
| A7525 |
Tracheostomy mask |
813 |
758 |
$3K |
| A4351 |
Straight tip urine catheter |
12 |
12 |
$2K |
| A7012 |
Nebulizer water collec devic |
513 |
342 |
$2K |
| A4206 |
1 cc sterile syringe&needle |
268 |
248 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
242 |
196 |
$2K |
| E0163 |
Commode chair with fixed arm |
25 |
25 |
$2K |
| A6258 |
Transparent film >16<=48 in |
14 |
12 |
$890.52 |