| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,797 |
1,714 |
$502K |
| E1390 |
Oxygen concentrator |
6,869 |
3,805 |
$385K |
| E0600 |
Suction pump portab hom modl |
7,627 |
4,393 |
$230K |
| E0445 |
Oximeter non-invasive |
777 |
298 |
$136K |
| E0430 |
Oxygen system gas portable |
4,102 |
1,858 |
$123K |
| T4522 |
Adult size brief/diaper med |
1,485 |
989 |
$105K |
| T4526 |
Adult size pull-on med |
1,230 |
817 |
$93K |
| E0601 |
Cont airway pressure device |
3,262 |
1,769 |
$87K |
| B4035 |
Enteral feed supp pump per d |
1,701 |
766 |
$75K |
| A4253 |
Blood glucose/reagent strips |
1,538 |
946 |
$69K |
| B4161 |
Ef ped hydrolyzed/amino acid |
369 |
183 |
$68K |
| B4152 |
Ef calorie dense>/=1.5kcal |
553 |
268 |
$67K |
| E0260 |
Hosp bed semi-electr w/ matt |
932 |
472 |
$53K |
| T4530 |
Ped size brief/diaper lg |
646 |
425 |
$50K |
| A4554 |
Disposable underpads |
3,138 |
2,255 |
$45K |
| T4532 |
Ped size pull-on lg |
698 |
301 |
$36K |
| A4351 |
Straight tip urine catheter |
250 |
142 |
$31K |
| E1150 |
Wheelchair standard w/ leg r |
1,234 |
416 |
$29K |
| B9002 |
Enter nutr inf pump any type |
898 |
464 |
$21K |
| E0570 |
Nebulizer with compression |
559 |
455 |
$18K |
| A4927 |
Non-sterile gloves |
2,230 |
1,194 |
$18K |
| E0431 |
Portable gaseous 02 |
1,683 |
1,319 |
$17K |
| B9998 |
Enteral supp not otherwise c |
803 |
454 |
$15K |
| B4150 |
Ef complet w/intact nutrient |
144 |
98 |
$12K |
| T4521 |
Adult size brief/diaper sm |
241 |
99 |
$10K |
| A4450 |
Non-waterproof tape |
182 |
149 |
$9K |
| A4259 |
Lancets per box |
893 |
607 |
$9K |
| T4531 |
Ped size pull-on sm/med |
117 |
62 |
$8K |
| T4528 |
Adult size pull-on xl |
96 |
63 |
$7K |
| B4100 |
Food thickener oral |
197 |
134 |
$7K |
| E0143 |
Walker folding wheeled w/o s |
142 |
85 |
$5K |
| K0001 |
Standard wheelchair |
687 |
534 |
$5K |
| A6216 |
Non-sterile gauze<=16 sq in |
122 |
96 |
$4K |
| T4535 |
Disposable liner/shield/pad |
45 |
38 |
$3K |
| E1070 |
Wheelchair detachable foot r |
65 |
28 |
$2K |
| A6219 |
Gauze <= 16 sq in w/border |
68 |
54 |
$2K |
| A4520 |
Incontinence garment anytype |
14 |
12 |
$1K |
| A4628 |
Oropharyngeal suction cath |
326 |
205 |
$1K |
| T4527 |
Adult size pull-on lg |
17 |
12 |
$1K |
| E0163 |
Commode chair with fixed arm |
24 |
13 |
$835.12 |
| A4322 |
Irrigation syringe |
84 |
61 |
$750.08 |
| B4155 |
Ef incomplete/modular |
62 |
25 |
$688.40 |
| A7038 |
Pos airway pressure filter |
89 |
73 |
$186.30 |
| A7035 |
Pos airway press headgear |
51 |
39 |
$72.84 |
| T4541 |
Large disposable underpad |
21 |
13 |
$0.00 |