| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L8699 |
Prosthetic implant nos |
1,787 |
1,580 |
$5.40M |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
589 |
409 |
$23K |
| B4035 |
Enteral feed supp pump per d |
198 |
197 |
$13K |
| A5063 |
Drain ostomy pouch w/flange |
296 |
277 |
$10K |
| E0260 |
Hosp bed semi-electr w/ matt |
541 |
540 |
$5K |
| B9002 |
Enter nutr inf pump any type |
161 |
160 |
$4K |
| A4406 |
Pectin based ostomy paste |
448 |
285 |
$3K |
| A7030 |
Cpap full face mask |
132 |
132 |
$3K |
| A4353 |
Intermittent urinary cath |
16 |
16 |
$3K |
| A7034 |
Nasal application device |
173 |
172 |
$2K |
| A4253 |
Blood glucose/reagent strips |
1,664 |
1,604 |
$2K |
| E0601 |
Cont airway pressure device |
504 |
504 |
$2K |
| A5131 |
Appliance cleaner |
140 |
138 |
$1K |
| K0001 |
Standard wheelchair |
415 |
414 |
$1K |
| A7035 |
Pos airway press headgear |
283 |
282 |
$1K |
| A7037 |
Pos airway pressure tubing |
303 |
303 |
$1K |
| B4034 |
Enter feed supkit syr by day |
51 |
50 |
$988.94 |
| E0776 |
Iv pole |
167 |
166 |
$789.48 |
| E0562 |
Humidifier heated used w pap |
660 |
659 |
$783.00 |
| E0135 |
Walker folding adjust/fixed |
57 |
57 |
$684.54 |
| A4456 |
Adhesive remover, wipes |
231 |
207 |
$615.00 |
| A4371 |
Skin barrier powder per oz |
252 |
217 |
$485.86 |
| A7038 |
Pos airway pressure filter |
479 |
475 |
$481.84 |
| A4259 |
Lancets per box |
1,635 |
1,578 |
$344.50 |
| E0163 |
Commode chair with fixed arm |
60 |
60 |
$271.93 |
| A7039 |
Filter, non disposable w pap |
61 |
61 |
$256.12 |
| E0185 |
Gel pressure mattress pad |
28 |
28 |
$186.72 |
| A7046 |
Repl water chamber, pap dev |
43 |
43 |
$130.92 |
| A5120 |
Skin barrier, wipe or swab |
148 |
147 |
$129.75 |
| A4452 |
Waterproof tape |
84 |
83 |
$125.00 |
| A7000 |
Disposable canister for pump |
41 |
40 |
$120.75 |
| A7036 |
Pos airway press chinstrap |
79 |
79 |
$100.56 |
| A7002 |
Tubing used w suction pump |
39 |
39 |
$26.88 |
| A4927 |
Non-sterile gloves |
40 |
40 |
$11.90 |
| A4670 |
Automatic bp monitor, dial |
1,434 |
1,406 |
$0.00 |
| E0607 |
Blood glucose monitor home |
68 |
68 |
$0.00 |
| E0570 |
Nebulizer with compression |
136 |
136 |
$0.00 |
| A4258 |
Lancet device each |
59 |
59 |
$0.00 |
| E0240 |
Bath/shower chair |
453 |
439 |
$0.00 |
| Q0513 |
Disp fee inhal drugs/30 days |
261 |
257 |
$0.00 |
| E0630 |
Patient lift hydraulic |
25 |
25 |
$0.00 |
| J7613 |
Albuterol non-comp unit |
126 |
125 |
$0.00 |
| E1399 |
Durable medical equipment mi |
85 |
82 |
$0.00 |
| E0431 |
Portable gaseous 02 |
124 |
119 |
$0.00 |
| E0470 |
Rad w/o backup non-inv intfc |
84 |
84 |
$0.00 |
| B4161 |
Ef ped hydrolyzed/amino acid |
21 |
21 |
$0.00 |
| E0143 |
Walker folding wheeled w/o s |
35 |
35 |
$0.00 |
| A4624 |
Tracheal suction tube |
23 |
21 |
$0.00 |
| E0181 |
Press pad alternating w/ pum |
67 |
67 |
$0.00 |
| E1392 |
Portable oxygen concentrator |
17 |
17 |
$0.00 |
| B4152 |
Ef calorie dense>/=1.5kcal |
28 |
28 |
$0.00 |
| E0156 |
Walker seat attachment |
23 |
23 |
$0.00 |
| E0465 |
Home vent invasive interface |
14 |
14 |
$0.00 |
| A4629 |
Tracheostomy care kit |
21 |
21 |
$0.00 |
| E0303 |
Hosp bed hvy dty xtra wide |
22 |
22 |
$0.00 |
| B4153 |
Ef hydrolyzed/amino acids |
29 |
29 |
$0.00 |
| E0600 |
Suction pump portab hom modl |
37 |
36 |
$0.00 |
| T4533 |
Youth size brief/diaper |
15 |
15 |
$0.00 |
| B4154 |
Ef spec metabolic noninherit |
22 |
21 |
$0.00 |
| E0973 |
W/ch access det adj armrest |
34 |
12 |
$0.00 |
| K0195 |
Elevating whlchair leg rests |
77 |
76 |
$0.00 |
| A4367 |
Ostomy belt |
15 |
15 |
$0.00 |
| K0739 |
Repair/svc dme non-oxygen eq |
77 |
74 |
$0.00 |
| K0003 |
Lightweight wheelchair |
21 |
21 |
$0.00 |
| K0006 |
Heavy duty wheelchair |
16 |
16 |
$0.00 |
| E1390 |
Oxygen concentrator |
246 |
246 |
$0.00 |
| E0471 |
Rad w/backup non inv intrfc |
27 |
27 |
$0.00 |