| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
10,070 |
9,874 |
$336K |
| B4153 |
Ef hydrolyzed/amino acids |
242 |
238 |
$320K |
| T4527 |
Adult size pull-on lg |
2,001 |
1,940 |
$268K |
| B4150 |
Ef complet w/intact nutrient |
858 |
814 |
$243K |
| B4035 |
Enteral feed supp pump per d |
935 |
880 |
$236K |
| T4523 |
Adult size brief/diaper lg |
2,223 |
2,161 |
$209K |
| E1390 |
Oxygen concentrator |
1,759 |
1,712 |
$161K |
| B9998 |
Enteral supp not otherwise c |
2,348 |
1,961 |
$150K |
| B4034 |
Enter feed supkit syr by day |
1,061 |
1,013 |
$132K |
| T4526 |
Adult size pull-on med |
1,113 |
1,100 |
$126K |
| A4351 |
Straight tip urine catheter |
422 |
405 |
$109K |
| T4522 |
Adult size brief/diaper med |
1,129 |
1,098 |
$106K |
| T4528 |
Adult size pull-on xl |
562 |
546 |
$90K |
| A4335 |
Incontinence supply |
11,513 |
11,299 |
$58K |
| T4535 |
Disposable liner/shield/pad |
1,652 |
1,610 |
$54K |
| T4525 |
Adult size pull-on sm |
433 |
415 |
$36K |
| T4532 |
Ped size pull-on lg |
281 |
267 |
$35K |
| A4624 |
Tracheal suction tube |
276 |
258 |
$32K |
| E0431 |
Portable gaseous 02 |
1,811 |
1,759 |
$30K |
| A7000 |
Disposable canister for pump |
1,095 |
1,044 |
$24K |
| T4521 |
Adult size brief/diaper sm |
256 |
247 |
$23K |
| A7002 |
Tubing used w suction pump |
1,103 |
1,057 |
$18K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
64 |
60 |
$17K |
| T4533 |
Youth size brief/diaper |
141 |
138 |
$13K |
| K0001 |
Standard wheelchair |
148 |
142 |
$7K |
| A4322 |
Irrigation syringe |
910 |
876 |
$7K |
| T1999 |
Noc retail items andsupplies |
573 |
553 |
$6K |
| A4628 |
Oropharyngeal suction cath |
1,003 |
948 |
$5K |
| A6216 |
Non-sterile gauze<=16 sq in |
271 |
262 |
$2K |
| A7003 |
Nebulizer administration set |
381 |
371 |
$698.84 |
| E0260 |
Hosp bed semi-electr w/ matt |
40 |
40 |
$474.03 |
| A7526 |
Tracheostomy tube collar |
52 |
48 |
$395.41 |
| A4217 |
Sterile water/saline, 500 ml |
12 |
12 |
$281.49 |