| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| Q5104 |
Injection, renflexis |
2,455 |
1,628 |
$12.12M |
| J2357 |
Omalizumab injection |
2,612 |
1,256 |
$11.96M |
| J1559 |
Hizentra injection |
2,182 |
1,052 |
$9.71M |
| E1390 |
Oxygen concentrator |
37,846 |
31,914 |
$4.46M |
| S9342 |
Hit enteral pump diem |
18,070 |
11,973 |
$3.54M |
| B4161 |
Ef ped hydrolyzed/amino acid |
5,704 |
4,561 |
$2.53M |
| A4353 |
Intermittent urinary cath |
2,470 |
1,711 |
$2.45M |
| J0585 |
Injection,onabotulinumtoxina |
1,767 |
1,325 |
$2.23M |
| E0601 |
Cont airway pressure device |
11,056 |
9,693 |
$1.96M |
| T4526 |
Adult size pull-on med |
8,493 |
6,557 |
$1.21M |
| A4554 |
Disposable underpads |
28,981 |
21,273 |
$1.16M |
| A7034 |
Nasal application device |
17,454 |
13,602 |
$1.04M |
| T4528 |
Adult size pull-on xl |
7,218 |
5,287 |
$1.01M |
| 99601 |
|
14,148 |
6,132 |
$983K |
| T4527 |
Adult size pull-on lg |
6,821 |
5,088 |
$974K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
7,776 |
6,153 |
$911K |
| E0465 |
Home vent invasive interface |
1,440 |
1,246 |
$761K |
| A4604 |
Tubing with heating element |
21,519 |
16,023 |
$745K |
| E0562 |
Humidifier heated used w pap |
11,756 |
10,428 |
$724K |
| E0603 |
Electric breast pump |
5,213 |
3,806 |
$724K |
| T4523 |
Adult size brief/diaper lg |
5,231 |
3,949 |
$650K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,341 |
922 |
$612K |
| A7030 |
Cpap full face mask |
8,760 |
6,928 |
$610K |
| A4351 |
Straight tip urine catheter |
3,127 |
2,348 |
$608K |
| T4524 |
Adult size brief/diaper xl |
4,603 |
3,395 |
$591K |
| A4624 |
Tracheal suction tube |
2,866 |
2,284 |
$580K |
| J2350 |
Injection, ocrelizumab, 1 mg |
17 |
12 |
$524K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
1,522 |
1,123 |
$520K |
| B4035 |
Enteral feed supp pump per d |
4,459 |
3,936 |
$493K |
| T4535 |
Disposable liner/shield/pad |
8,914 |
6,740 |
$431K |
| E0431 |
Portable gaseous 02 |
19,584 |
15,857 |
$426K |
| B4149 |
Ef blenderized foods |
1,539 |
1,231 |
$412K |
| B4153 |
Ef hydrolyzed/amino acids |
875 |
731 |
$404K |
| J1950 |
Leuprolide acetate /3.75 mg |
41 |
27 |
$397K |
| A6212 |
Foam drg <=16 sq in w/border |
1,294 |
908 |
$396K |
| T4522 |
Adult size brief/diaper med |
4,204 |
3,343 |
$390K |
| A4927 |
Non-sterile gloves |
27,912 |
20,717 |
$341K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,474 |
1,061 |
$335K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,809 |
3,192 |
$325K |
| B4150 |
Ef complet w/intact nutrient |
4,002 |
3,197 |
$321K |
| K0738 |
Portable gas oxygen system |
9,084 |
7,740 |
$318K |
| A7035 |
Pos airway press headgear |
14,741 |
12,125 |
$316K |
| E0265 |
Hosp bed total electr w/ mat |
1,988 |
1,489 |
$309K |
| S9338 |
Hit immunotherapy diem |
6,317 |
1,641 |
$304K |
| A7032 |
Replacement nasal cushion |
9,812 |
8,016 |
$300K |
| E0143 |
Walker folding wheeled w/o s |
6,817 |
5,937 |
$292K |
| S9366 |
Hit tpn 2 liter diem |
421 |
60 |
$283K |
| S9500 |
Hit antibiotic q24h diem |
1,986 |
567 |
$272K |
| B4224 |
Parenteral administration ki |
1,979 |
470 |
$260K |
| 99602 |
Nursing care in home rn |
3,973 |
2,362 |
$237K |
| A7520 |
Trach/laryn tube non-cuffed |
2,884 |
2,350 |
$237K |
| E1392 |
Portable oxygen concentrator |
6,639 |
5,768 |
$230K |
| A4520 |
Incontinence garment anytype |
2,385 |
1,449 |
$227K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,472 |
855 |
$223K |
| A4385 |
Ost skn barrier sld ext wear |
2,553 |
1,531 |
$207K |
| B4220 |
Parenteral supply kit premix |
1,979 |
470 |
$203K |
| A4629 |
Tracheostomy care kit |
2,335 |
2,014 |
$194K |
| E0260 |
Hosp bed semi-electr w/ matt |
5,895 |
5,346 |
$193K |
| E0570 |
Nebulizer with compression |
7,500 |
6,437 |
$191K |
| K0001 |
Standard wheelchair |
6,937 |
5,580 |
$189K |
| A4623 |
Tracheostomy inner cannula |
1,692 |
1,367 |
$184K |
| A7031 |
Replacement facemask interfa |
5,097 |
4,116 |
$182K |
| A7038 |
Pos airway pressure filter |
27,752 |
22,333 |
$178K |
| S8120 |
O2 contents gas cubic ft |
5,423 |
2,482 |
$178K |
| A7526 |
Tracheostomy tube collar |
2,672 |
2,303 |
$176K |
| A6266 |
Impreg gauze no h20/sal/yard |
732 |
558 |
$174K |
| A4670 |
Automatic bp monitor, dial |
3,722 |
2,700 |
$168K |
| E0470 |
Rad w/o backup non-inv intfc |
855 |
742 |
$167K |
| S9379 |
Hit noc per diem |
2,420 |
1,447 |
$165K |
| A7046 |
Repl water chamber, pap dev |
13,381 |
10,720 |
$162K |
| T4525 |
Adult size pull-on sm |
1,273 |
987 |
$159K |
| L4361 |
Pneuma/vac walk boot pre ots |
649 |
511 |
$156K |
| A4606 |
Oxygen probe used w oximeter |
1,688 |
1,371 |
$155K |
| A7033 |
Replacement nasal pillows |
5,768 |
4,709 |
$145K |
| A4452 |
Waterproof tape |
1,394 |
950 |
$143K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
990 |
688 |
$143K |
| T4532 |
Ped size pull-on lg |
1,006 |
836 |
$133K |
| A4357 |
Bedside drainage bag |
3,501 |
2,169 |
$128K |
| S9374 |
Hit hydra 1 liter diem |
1,687 |
487 |
$128K |
| B4155 |
Ef incomplete/modular |
1,353 |
1,050 |
$116K |
| Q5121 |
Inj. avsola, 10 mg |
46 |
38 |
$113K |
| A6021 |
Collagen dressing <=16 sq in |
214 |
120 |
$109K |
| B4158 |
Ef ped complete intact nut |
875 |
723 |
$108K |
| B4154 |
Ef spec metabolic noninherit |
542 |
458 |
$105K |
| S9343 |
Hit enteral bolus nurs |
1,199 |
839 |
$96K |
| S9359 |
Hit anti-tnf per diem |
2,505 |
1,890 |
$94K |
| A4425 |
Ost pch drain for barrier fl |
1,196 |
873 |
$84K |
| A4221 |
Supp non-insulin inf cath/wk |
2,685 |
1,470 |
$81K |
| A5061 |
Pouch drainable w barrier at |
982 |
758 |
$71K |
| E0445 |
Oximeter non-invasive |
194 |
178 |
$70K |
| E0630 |
Patient lift hydraulic |
1,700 |
1,464 |
$69K |
| A7037 |
Pos airway pressure tubing |
4,077 |
3,620 |
$69K |
| E0163 |
Commode chair with fixed arm |
1,271 |
1,086 |
$69K |
| K0195 |
Elevating whlchair leg rests |
5,904 |
4,804 |
$68K |
| E0600 |
Suction pump portab hom modl |
2,155 |
1,868 |
$67K |
| B4103 |
Ef ped fluid and electrolyte |
766 |
600 |
$66K |
| A4483 |
Moisture exchanger |
657 |
496 |
$63K |
| L3809 |
Whfo w/o joints pre ots |
383 |
262 |
$59K |
| K0007 |
Extra heavy duty wheelchair |
498 |
447 |
$58K |
| K0552 |
Sup/ext non-ins inf pump syr |
129 |
99 |
$57K |
| A4394 |
Ostomy pouch liq deodorant |
1,904 |
1,442 |
$55K |
| A7005 |
Nondisposable nebulizer set |
2,634 |
2,205 |
$52K |
| A6402 |
Sterile gauze <= 16 sq in |
4,165 |
3,196 |
$52K |
| L3908 |
Who cock-up nonmolde pre ots |
1,274 |
849 |
$51K |
| A4406 |
Pectin based ostomy paste |
1,589 |
1,092 |
$50K |
| A7000 |
Disposable canister for pump |
4,392 |
3,773 |
$50K |
| K0003 |
Lightweight wheelchair |
993 |
868 |
$49K |
| A4409 |
Ost skn barr convex <=4 sq i |
555 |
467 |
$49K |
| A5120 |
Skin barrier, wipe or swab |
4,169 |
2,966 |
$49K |
| A7002 |
Tubing used w suction pump |
4,371 |
3,712 |
$46K |
| B4034 |
Enter feed supkit syr by day |
1,197 |
1,047 |
$43K |
| A4628 |
Oropharyngeal suction cath |
3,456 |
2,879 |
$43K |
| A4553 |
Nondisp underpads, all sizes |
3,148 |
2,803 |
$43K |
| A4349 |
Disposable male external cat |
569 |
472 |
$39K |
| A6446 |
Conform band s w>=3" <5"/yd |
764 |
560 |
$37K |
| B4088 |
Gastro/jejuno tube, low-pro |
588 |
557 |
$34K |
| E0149 |
Heavy duty wheeled walker |
582 |
504 |
$34K |
| A7036 |
Pos airway press chinstrap |
2,720 |
2,264 |
$32K |
| A4217 |
Sterile water/saline, 500 ml |
1,676 |
1,224 |
$31K |
| A4456 |
Adhesive remover, wipes |
2,111 |
1,532 |
$30K |
| S9502 |
Hit antibiotic q8h diem |
327 |
86 |
$29K |
| A4358 |
Urinary leg or abdomen bag |
1,061 |
613 |
$29K |
| L1820 |
Ko elas w/ condyle pads & jo |
300 |
226 |
$28K |
| A4450 |
Non-waterproof tape |
3,208 |
2,266 |
$28K |
| A4216 |
Sterile water/saline, 10 ml |
1,743 |
1,331 |
$27K |
| T4521 |
Adult size brief/diaper sm |
332 |
236 |
$26K |
| A5063 |
Drain ostomy pouch w/flange |
375 |
331 |
$24K |
| E0156 |
Walker seat attachment |
1,312 |
1,080 |
$23K |
| L8501 |
Tracheostomy speaking valve |
340 |
299 |
$21K |
| E0973 |
W/ch access det adj armrest |
1,579 |
732 |
$21K |
| A4402 |
Lubricant per ounce |
1,225 |
832 |
$20K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,953 |
1,323 |
$17K |
| E0240 |
Bath/shower chair |
377 |
271 |
$16K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
108 |
101 |
$16K |
| A6260 |
Wound cleanser any type/size |
605 |
387 |
$16K |
| A4362 |
Solid skin barrier |
272 |
187 |
$15K |
| A7003 |
Nebulizer administration set |
4,224 |
3,442 |
$14K |
| E0471 |
Rad w/backup non inv intrfc |
39 |
38 |
$14K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
135 |
125 |
$13K |
| J7307 |
Etonogestrel implant system |
33 |
12 |
$12K |
| A4371 |
Skin barrier powder per oz |
1,683 |
1,186 |
$12K |
| E0100 |
Cane adjust/fixed with tip |
607 |
509 |
$11K |
| A7525 |
Tracheostomy mask |
1,688 |
1,207 |
$11K |
| A4332 |
Lube sterile packet |
2,002 |
1,658 |
$11K |
| A7039 |
Filter, non disposable w pap |
1,203 |
1,000 |
$10K |
| J3370 |
Vancomycin hcl injection |
41 |
12 |
$9K |
| A7007 |
Lg vol nebulizer disposable |
1,116 |
893 |
$9K |
| E0114 |
Crutch underarm pair no wood |
178 |
138 |
$8K |
| B9002 |
Enter nutr inf pump any type |
218 |
193 |
$8K |
| S9375 |
Hit hydra 2 liter diem |
33 |
13 |
$8K |
| S8121 |
O2 contents liquid lb |
409 |
126 |
$7K |
| A4310 |
Insert tray w/o bag/cath |
216 |
142 |
$7K |
| A7012 |
Nebulizer water collec devic |
1,172 |
944 |
$7K |
| A7015 |
Aerosol mask used w nebulize |
2,202 |
1,760 |
$6K |
| A4388 |
Drainable pch w ex wear barr |
49 |
36 |
$6K |
| E0434 |
Portable liquid 02 |
209 |
183 |
$6K |
| T4534 |
Youth size pull-on |
39 |
36 |
$6K |
| A7507 |
Integrated filter & holder |
69 |
64 |
$5K |
| E0181 |
Press pad alternating w/ pum |
375 |
344 |
$5K |
| T4537 |
Reusable underpad bed size |
2,579 |
1,691 |
$4K |
| S5501 |
Hit complex cath care |
37 |
28 |
$4K |
| L1902 |
Afo ankle gauntlet pre ots |
57 |
37 |
$4K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
30 |
14 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
38 |
16 |
$3K |
| A6445 |
Conform band s w <3"/yd |
76 |
71 |
$3K |
| S8189 |
Trach supply noc |
301 |
263 |
$3K |
| A9999 |
Dme supply or accessory, nos |
128 |
51 |
$3K |
| A6449 |
Lt compres band >=3" <5"/yd |
45 |
28 |
$2K |
| A7018 |
Water distilled w/nebulizer |
785 |
698 |
$2K |
| E0303 |
Hosp bed hvy dty xtra wide |
13 |
12 |
$2K |
| E0565 |
Compressor air power source |
26 |
24 |
$2K |
| T4533 |
Youth size brief/diaper |
13 |
12 |
$1K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
13 |
12 |
$1K |
| A4253 |
Blood glucose/reagent strips |
16 |
15 |
$1K |
| L0625 |
Lo flex l1-below l5 pre ots |
26 |
12 |
$985.32 |
| A4244 |
Alcohol or peroxide per pint |
22 |
17 |
$933.28 |
| A6248 |
Hydrogel drsg gel filler |
13 |
12 |
$861.89 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
34 |
12 |
$813.98 |
| S9341 |
Hit enteral grav diem |
14 |
12 |
$735.60 |
| A4245 |
Alcohol wipes per box |
270 |
247 |
$643.11 |
| A4367 |
Ostomy belt |
52 |
51 |
$526.12 |
| E0443 |
Portable 02 contents, gas |
655 |
626 |
$423.21 |
| S9330 |
Hit cont chem diem |
18 |
12 |
$400.55 |
| E0165 |
Commode chair with detacharm |
13 |
12 |
$395.31 |
| A7010 |
Disposable corrugated tubing |
24 |
24 |
$297.19 |
| E1226 |
Manual fully reclining back |
13 |
13 |
$291.41 |
| J9190 |
Fluorouracil injection |
21 |
14 |
$189.87 |
| A4259 |
Lancets per box |
14 |
13 |
$163.21 |