| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home vent invasive interface |
827 |
756 |
$720K |
| B4035 |
Enteral feed supp pump per d |
1,791 |
1,640 |
$465K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,412 |
950 |
$323K |
| E0482 |
Cough stimulating device |
1,168 |
1,160 |
$317K |
| E1390 |
Oxygen concentrator |
2,642 |
2,620 |
$274K |
| B9998 |
Enteral supp not otherwise c |
2,530 |
2,090 |
$186K |
| B4161 |
Ef ped hydrolyzed/amino acid |
339 |
208 |
$178K |
| A4624 |
Tracheal suction tube |
780 |
686 |
$114K |
| A4606 |
Oxygen probe used w oximeter |
1,974 |
1,176 |
$98K |
| A4629 |
Tracheostomy care kit |
1,055 |
946 |
$96K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
680 |
670 |
$85K |
| A7000 |
Disposable canister for pump |
1,966 |
1,790 |
$77K |
| E0466 |
Home vent non-invasive inter |
127 |
125 |
$72K |
| B4152 |
Ef calorie dense>/=1.5kcal |
354 |
226 |
$72K |
| A9900 |
Supply/accessory/service |
567 |
410 |
$59K |
| B4034 |
Enter feed supkit syr by day |
368 |
331 |
$48K |
| E0431 |
Portable gaseous 02 |
2,386 |
2,366 |
$47K |
| A4554 |
Disposable underpads |
1,354 |
1,233 |
$41K |
| A4322 |
Irrigation syringe |
1,737 |
1,577 |
$35K |
| A4320 |
Irrigation tray |
711 |
711 |
$33K |
| A6402 |
Sterile gauze <= 16 sq in |
1,504 |
1,455 |
$31K |
| A7520 |
Trach/laryn tube non-cuffed |
593 |
587 |
$30K |
| A7526 |
Tracheostomy tube collar |
989 |
934 |
$29K |
| A7002 |
Tubing used w suction pump |
2,186 |
1,759 |
$27K |
| A4452 |
Waterproof tape |
1,127 |
1,064 |
$26K |
| A4623 |
Tracheostomy inner cannula |
325 |
316 |
$24K |
| T1999 |
Noc retail items andsupplies |
2,461 |
1,552 |
$21K |
| A5200 |
Percutaneous catheter anchor |
904 |
900 |
$17K |
| E0445 |
Oximeter non-invasive |
84 |
80 |
$17K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
454 |
444 |
$16K |
| A4216 |
Sterile water/saline, 10 ml |
550 |
532 |
$10K |
| A4628 |
Oropharyngeal suction cath |
1,747 |
1,723 |
$10K |
| A7037 |
Pos airway pressure tubing |
484 |
479 |
$10K |
| A7038 |
Pos airway pressure filter |
1,410 |
1,386 |
$8K |
| A4927 |
Non-sterile gloves |
1,144 |
1,129 |
$8K |
| A7012 |
Nebulizer water collec devic |
1,563 |
1,545 |
$7K |
| E0601 |
Cont airway pressure device |
88 |
88 |
$7K |
| A4335 |
Incontinence supply |
1,299 |
1,234 |
$7K |
| A5131 |
Appliance cleaner |
460 |
458 |
$6K |
| A7007 |
Lg vol nebulizer disposable |
1,035 |
1,022 |
$5K |
| B4036 |
Enteral feed sup kit grav by |
25 |
25 |
$5K |
| A4247 |
Betadine/iodine swabs/wipes |
498 |
434 |
$5K |
| A4465 |
Non-elastic extremity binder |
185 |
180 |
$5K |
| A4364 |
Adhesive, liquid or equal |
267 |
266 |
$4K |
| E0562 |
Humidifier heated used w pap |
231 |
231 |
$4K |
| A7003 |
Nebulizer administration set |
1,238 |
1,226 |
$4K |
| S8301 |
Infect control supplies nos |
172 |
171 |
$4K |
| A7010 |
Disposable corrugated tubing |
241 |
235 |
$4K |
| A4456 |
Adhesive remover, wipes |
322 |
321 |
$4K |
| A4618 |
Breathing circuits |
203 |
197 |
$2K |
| K0001 |
Standard wheelchair |
87 |
83 |
$2K |
| A4450 |
Non-waterproof tape |
504 |
488 |
$2K |
| A7525 |
Tracheostomy mask |
801 |
608 |
$1K |
| A4928 |
Surgical mask |
100 |
100 |
$1K |
| A7006 |
Filtered nebulizer admin set |
205 |
205 |
$1K |
| A4244 |
Alcohol or peroxide per pint |
683 |
677 |
$1K |
| A4245 |
Alcohol wipes per box |
212 |
205 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
721 |
702 |
$866.68 |
| K0195 |
Elevating whlchair leg rests |
87 |
83 |
$848.62 |
| B9002 |
Enter nutr inf pump any type |
12 |
12 |
$802.95 |
| A6250 |
Skin seal protect moisturizr |
125 |
125 |
$646.31 |
| A4332 |
Lube sterile packet |
153 |
150 |
$627.24 |
| A7013 |
Disposable compressor filter |
469 |
466 |
$486.72 |
| A4217 |
Sterile water/saline, 500 ml |
13 |
13 |
$340.90 |
| A7005 |
Nondisposable nebulizer set |
13 |
13 |
$237.58 |
| A4402 |
Lubricant per ounce |
24 |
24 |
$110.36 |
| E0776 |
Iv pole |
12 |
12 |
$65.05 |
| A4617 |
Mouth piece |
12 |
12 |
$61.80 |
| A4620 |
Variable concentration mask |
16 |
14 |
$12.81 |