| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,788 |
1,378 |
$359K |
| E0601 |
Cont airway pressure device |
2,693 |
2,526 |
$240K |
| B4035 |
Enteral feed supp pump per d |
2,114 |
1,904 |
$205K |
| A7030 |
Cpap full face mask |
1,494 |
1,388 |
$141K |
| B9998 |
Enteral supp not otherwise c |
1,107 |
927 |
$141K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,179 |
1,011 |
$59K |
| B4034 |
Enter feed supkit syr by day |
964 |
840 |
$57K |
| E0562 |
Humidifier heated used w pap |
716 |
669 |
$57K |
| A7031 |
Replacement facemask interfa |
1,534 |
1,393 |
$55K |
| E0470 |
Rad w/o backup non-inv intfc |
198 |
186 |
$50K |
| A7037 |
Pos airway pressure tubing |
1,937 |
1,808 |
$44K |
| B4150 |
Ef complet w/intact nutrient |
741 |
621 |
$44K |
| B4154 |
Ef spec metabolic noninherit |
486 |
434 |
$32K |
| E1390 |
Oxygen concentrator |
415 |
375 |
$30K |
| E0570 |
Nebulizer with compression |
997 |
912 |
$29K |
| A6402 |
Sterile gauze <= 16 sq in |
1,174 |
927 |
$27K |
| A7035 |
Pos airway press headgear |
1,182 |
1,092 |
$25K |
| A7034 |
Nasal application device |
326 |
312 |
$21K |
| E0260 |
Hosp bed semi-electr w/ matt |
385 |
363 |
$14K |
| A7038 |
Pos airway pressure filter |
1,960 |
1,826 |
$11K |
| A7039 |
Filter, non disposable w pap |
1,174 |
1,085 |
$9K |
| K0195 |
Elevating whlchair leg rests |
454 |
418 |
$7K |
| A7000 |
Disposable canister for pump |
818 |
718 |
$6K |
| K0001 |
Standard wheelchair |
423 |
395 |
$5K |
| A4624 |
Tracheal suction tube |
35 |
26 |
$5K |
| A7002 |
Tubing used w suction pump |
821 |
715 |
$4K |
| A9900 |
Supply/accessory/service |
946 |
617 |
$4K |
| A4628 |
Oropharyngeal suction cath |
773 |
668 |
$4K |
| A7032 |
Replacement nasal cushion |
129 |
123 |
$4K |
| A7003 |
Nebulizer administration set |
876 |
801 |
$4K |
| A4629 |
Tracheostomy care kit |
63 |
48 |
$3K |
| A4450 |
Non-waterproof tape |
194 |
176 |
$2K |
| B9002 |
Enter nutr inf pump any type |
78 |
67 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
556 |
498 |
$1K |
| A7526 |
Tracheostomy tube collar |
81 |
73 |
$423.74 |
| A4357 |
Bedside drainage bag |
12 |
12 |
$18.86 |