| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S8189 |
Trach supply noc |
13,153 |
2,524 |
$1.39M |
| B4035 |
Enteral feed supp pump per d |
2,420 |
1,978 |
$500K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,263 |
1,040 |
$492K |
| B9998 |
Enteral supp not otherwise c |
4,355 |
2,584 |
$435K |
| A4624 |
Tracheal suction tube |
2,020 |
1,555 |
$398K |
| B4034 |
Enter feed supkit syr by day |
1,360 |
1,182 |
$149K |
| E0465 |
Home vent invasive interface |
194 |
144 |
$137K |
| A4605 |
Trach suction cath close sys |
330 |
269 |
$129K |
| A6402 |
Sterile gauze <= 16 sq in |
2,711 |
2,154 |
$111K |
| A4606 |
Oxygen probe used w oximeter |
1,160 |
915 |
$103K |
| A4618 |
Breathing circuits |
1,094 |
987 |
$100K |
| A4629 |
Tracheostomy care kit |
2,073 |
1,683 |
$65K |
| T4534 |
Youth size pull-on |
218 |
198 |
$59K |
| A7000 |
Disposable canister for pump |
3,255 |
2,957 |
$57K |
| A7526 |
Tracheostomy tube collar |
2,652 |
2,481 |
$53K |
| E1399 |
Durable medical equipment mi |
103 |
94 |
$51K |
| A9900 |
Supply/accessory/service |
4,167 |
2,222 |
$44K |
| A4927 |
Non-sterile gloves |
2,467 |
1,955 |
$40K |
| A7002 |
Tubing used w suction pump |
4,728 |
2,950 |
$39K |
| B4150 |
Ef complet w/intact nutrient |
280 |
218 |
$30K |
| S8999 |
Resuscitation bag |
252 |
242 |
$25K |
| A7003 |
Nebulizer administration set |
3,146 |
2,657 |
$20K |
| E0260 |
Hosp bed semi-electr w/ matt |
443 |
405 |
$17K |
| A4616 |
Tubing (oxygen) per foot |
496 |
353 |
$16K |
| B4161 |
Ef ped hydrolyzed/amino acid |
15 |
12 |
$14K |
| T4522 |
Adult size brief/diaper med |
86 |
75 |
$13K |
| A7037 |
Pos airway pressure tubing |
879 |
829 |
$12K |
| A4628 |
Oropharyngeal suction cath |
1,618 |
1,505 |
$11K |
| E0601 |
Cont airway pressure device |
756 |
741 |
$11K |
| A4623 |
Tracheostomy inner cannula |
69 |
63 |
$9K |
| A7046 |
Repl water chamber, pap dev |
506 |
457 |
$7K |
| L8501 |
Tracheostomy speaking valve |
92 |
87 |
$7K |
| E1390 |
Oxygen concentrator |
98 |
91 |
$6K |
| A7525 |
Tracheostomy mask |
1,201 |
1,002 |
$4K |
| A7038 |
Pos airway pressure filter |
1,087 |
1,004 |
$4K |
| K0001 |
Standard wheelchair |
445 |
430 |
$3K |
| A7035 |
Pos airway press headgear |
302 |
294 |
$2K |
| B4152 |
Ef calorie dense>/=1.5kcal |
14 |
12 |
$2K |
| A7007 |
Lg vol nebulizer disposable |
278 |
225 |
$2K |
| E0630 |
Patient lift hydraulic |
27 |
24 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
316 |
275 |
$2K |
| T4523 |
Adult size brief/diaper lg |
16 |
16 |
$2K |
| A7012 |
Nebulizer water collec devic |
243 |
207 |
$2K |
| A7030 |
Cpap full face mask |
28 |
28 |
$686.37 |
| A7039 |
Filter, non disposable w pap |
114 |
114 |
$216.31 |
| T2028 |
Special supply, nos waiver |
20 |
20 |
$0.00 |
| T4541 |
Large disposable underpad |
36 |
36 |
$0.00 |