| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
1,015 |
840 |
$386K |
| A4353 |
Intermittent urinary cath |
1,749 |
1,532 |
$192K |
| E0601 |
Cont airway pressure device |
61,427 |
59,718 |
$187K |
| E0562 |
Humidifier heated used w pap |
63,522 |
61,640 |
$184K |
| E1392 |
Portable oxygen concentrator |
6,622 |
5,957 |
$159K |
| E0607 |
Blood glucose monitor home |
1,907 |
1,665 |
$131K |
| E0260 |
Hosp bed semi-electr w/ matt |
48,848 |
47,717 |
$107K |
| A7030 |
Cpap full face mask |
5,812 |
5,334 |
$103K |
| B4035 |
Enteral feed supp pump per d |
2,854 |
2,487 |
$86K |
| A6550 |
Neg pres wound ther drsg set |
934 |
673 |
$79K |
| A7034 |
Nasal application device |
5,098 |
4,641 |
$63K |
| S9494 |
Hit antibiotic total diem |
460 |
239 |
$56K |
| E1390 |
Oxygen concentrator |
20,571 |
20,104 |
$50K |
| E0470 |
Rad w/o backup non-inv intfc |
8,050 |
7,784 |
$46K |
| K0001 |
Standard wheelchair |
44,909 |
43,769 |
$43K |
| A4629 |
Tracheostomy care kit |
1,893 |
1,739 |
$39K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,678 |
1,488 |
$35K |
| A7037 |
Pos airway pressure tubing |
9,590 |
8,769 |
$33K |
| B4153 |
Ef hydrolyzed/amino acids |
752 |
667 |
$32K |
| A4624 |
Tracheal suction tube |
2,923 |
2,356 |
$31K |
| A7035 |
Pos airway press headgear |
5,426 |
4,798 |
$27K |
| B4154 |
Ef spec metabolic noninherit |
854 |
768 |
$25K |
| E0471 |
Rad w/backup non inv intrfc |
5,160 |
5,082 |
$24K |
| E0600 |
Suction pump portab hom modl |
7,293 |
7,094 |
$20K |
| B4034 |
Enter feed supkit syr by day |
1,140 |
1,049 |
$18K |
| E2402 |
Neg press wound therapy pump |
1,093 |
1,040 |
$18K |
| A7526 |
Tracheostomy tube collar |
983 |
877 |
$16K |
| E0277 |
Powered pres-redu air mattrs |
1,042 |
1,009 |
$15K |
| E0185 |
Gel pressure mattress pad |
744 |
661 |
$15K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
13 |
12 |
$14K |
| A7000 |
Disposable canister for pump |
3,102 |
2,832 |
$14K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,152 |
1,048 |
$13K |
| A4253 |
Blood glucose/reagent strips |
5,739 |
4,732 |
$12K |
| E0143 |
Walker folding wheeled w/o s |
1,075 |
940 |
$12K |
| A7508 |
Housing & integrated adhesiv |
747 |
665 |
$11K |
| A4425 |
Ost pch drain for barrier fl |
756 |
636 |
$11K |
| E0303 |
Hosp bed hvy dty xtra wide |
2,615 |
2,576 |
$10K |
| A4427 |
Ost pch drain/barr lk flng/f |
866 |
785 |
$10K |
| A7038 |
Pos airway pressure filter |
8,927 |
8,040 |
$9K |
| E0135 |
Walker folding adjust/fixed |
1,472 |
1,363 |
$8K |
| A5131 |
Appliance cleaner |
874 |
769 |
$8K |
| E0776 |
Iv pole |
6,143 |
5,989 |
$8K |
| A7039 |
Filter, non disposable w pap |
6,103 |
5,597 |
$7K |
| K0195 |
Elevating whlchair leg rests |
18,213 |
17,648 |
$7K |
| B9002 |
Enter nutr inf pump any type |
5,906 |
5,765 |
$7K |
| E0181 |
Press pad alternating w/ pum |
7,966 |
7,736 |
$7K |
| E0163 |
Commode chair with fixed arm |
1,009 |
951 |
$6K |
| K0006 |
Heavy duty wheelchair |
2,298 |
2,245 |
$6K |
| A4618 |
Breathing circuits |
861 |
757 |
$5K |
| E0973 |
W/ch access det adj armrest |
5,863 |
5,731 |
$5K |
| E0156 |
Walker seat attachment |
523 |
447 |
$5K |
| A4927 |
Non-sterile gloves |
302 |
264 |
$4K |
| K0003 |
Lightweight wheelchair |
1,072 |
1,032 |
$4K |
| E0431 |
Portable gaseous 02 |
15,037 |
14,757 |
$4K |
| A7036 |
Pos airway press chinstrap |
1,706 |
1,511 |
$4K |
| A7002 |
Tubing used w suction pump |
4,261 |
2,153 |
$3K |
| A5063 |
Drain ostomy pouch w/flange |
301 |
260 |
$3K |
| A4406 |
Pectin based ostomy paste |
1,034 |
919 |
$3K |
| E0630 |
Patient lift hydraulic |
2,177 |
2,130 |
$3K |
| A7046 |
Repl water chamber, pap dev |
408 |
301 |
$3K |
| A4604 |
Tubing with heating element |
160 |
133 |
$2K |
| E0935 |
Cont pas motion exercise dev |
28 |
19 |
$2K |
| B9998 |
Enteral supp not otherwise c |
42 |
24 |
$2K |
| E0445 |
Oximeter non-invasive |
3,091 |
3,053 |
$1K |
| A4259 |
Lancets per box |
5,549 |
4,591 |
$1K |
| E1226 |
Manual fully reclining back |
537 |
536 |
$1K |
| A4371 |
Skin barrier powder per oz |
1,535 |
1,400 |
$1K |
| B4088 |
Gastro/jejuno tube, low-pro |
239 |
204 |
$1K |
| A4216 |
Sterile water/saline, 10 ml |
405 |
380 |
$1K |
| A4367 |
Ostomy belt |
746 |
675 |
$1K |
| E0570 |
Nebulizer with compression |
6,252 |
6,155 |
$766.00 |
| E0561 |
Humidifier nonheated w pap |
1,204 |
1,182 |
$677.24 |
| A4405 |
Nonpectin based ostomy paste |
477 |
433 |
$543.96 |
| E0149 |
Heavy duty wheeled walker |
551 |
542 |
$242.20 |
| A4456 |
Adhesive remover, wipes |
1,207 |
1,101 |
$145.55 |
| A4452 |
Waterproof tape |
1,040 |
947 |
$110.20 |
| A4369 |
Skin barrier liquid per oz |
115 |
105 |
$104.28 |
| E0439 |
Stationary liquid 02 |
194 |
194 |
$85.10 |
| K0007 |
Extra heavy duty wheelchair |
623 |
620 |
$56.59 |
| A5120 |
Skin barrier, wipe or swab |
846 |
757 |
$40.71 |
| B4087 |
Gastro/jejuno tube, std |
12 |
12 |
$39.88 |
| E0434 |
Portable liquid 02 |
193 |
193 |
$17.46 |
| A6216 |
Non-sterile gauze<=16 sq in |
427 |
390 |
$6.00 |
| A4450 |
Non-waterproof tape |
123 |
98 |
$5.40 |
| E2201 |
Man w/ch acc seat w>=20"<24" |
19 |
19 |
$0.00 |
| K0010 |
Stnd wt frame power whlchr |
15 |
15 |
$0.00 |
| E0272 |
Mattress foam rubber |
12 |
12 |
$0.00 |
| A4415 |
Ost skn barr w/o conv >4 sqi |
50 |
47 |
$0.00 |
| E0465 |
Home vent invasive interface |
1,347 |
1,306 |
$0.00 |
| E0442 |
Stationary o2 contents, liq |
86 |
37 |
$0.00 |
| E0424 |
Stationary compressed gas 02 |
66 |
66 |
$0.00 |
| E1038 |
Transport chair pt wt<=300lb |
21 |
21 |
$0.00 |
| B4149 |
Ef blenderized foods |
13 |
12 |
$0.00 |
| E2367 |
Battery charger, dual mode |
22 |
22 |
$0.00 |