| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
5,955 |
5,623 |
$164K |
| B4150 |
Ef complet w/intact nutrient |
3,242 |
3,130 |
$95K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,136 |
2,044 |
$65K |
| B4154 |
Ef spec metabolic noninherit |
484 |
445 |
$30K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,492 |
1,411 |
$25K |
| A4314 |
Cath w/drainage 2-way latex |
4,563 |
4,451 |
$19K |
| B9002 |
Enter nutr inf pump any type |
2,157 |
1,975 |
$17K |
| A4357 |
Bedside drainage bag |
5,631 |
5,459 |
$12K |
| A5063 |
Drain ostomy pouch w/flange |
967 |
928 |
$11K |
| A6266 |
Impreg gauze no h20/sal/yard |
331 |
284 |
$9K |
| A7526 |
Tracheostomy tube collar |
453 |
453 |
$6K |
| A4358 |
Urinary leg or abdomen bag |
2,300 |
2,232 |
$6K |
| A4385 |
Ost skn barrier sld ext wear |
254 |
241 |
$5K |
| A4623 |
Tracheostomy inner cannula |
136 |
136 |
$4K |
| A4334 |
Urinary cath leg strap |
3,486 |
3,417 |
$3K |
| B4034 |
Enter feed supkit syr by day |
229 |
209 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
3,541 |
3,381 |
$3K |
| A5061 |
Pouch drainable w barrier at |
245 |
232 |
$3K |
| A4394 |
Ostomy pouch liq deodorant |
905 |
862 |
$2K |
| A4333 |
Urinary cath anchor device |
857 |
827 |
$2K |
| A4362 |
Solid skin barrier |
133 |
131 |
$2K |
| A5054 |
Clsd ostomy pouch w/flange |
80 |
70 |
$2K |
| A4407 |
Ext wear ost skn barr <=4sq" |
54 |
52 |
$2K |
| A4409 |
Ost skn barr convex <=4 sq i |
67 |
64 |
$1K |
| A6196 |
Alginate dressing <=16 sq in |
52 |
41 |
$1K |
| A4432 |
Os pch urine w bar/fange/tap |
103 |
89 |
$1K |
| A4425 |
Ost pch drain for barrier fl |
147 |
135 |
$1K |
| E0776 |
Iv pole |
564 |
537 |
$478.13 |
| A4406 |
Pectin based ostomy paste |
188 |
168 |
$462.60 |
| A4629 |
Tracheostomy care kit |
15 |
13 |
$360.24 |
| A5131 |
Appliance cleaner |
94 |
85 |
$346.90 |
| B4087 |
Gastro/jejuno tube, std |
51 |
51 |
$274.00 |
| B4155 |
Ef incomplete/modular |
43 |
41 |
$143.70 |
| A6446 |
Conform band s w>=3" <5"/yd |
15 |
12 |
$66.24 |
| A6402 |
Sterile gauze <= 16 sq in |
27 |
25 |
$36.35 |
| A4450 |
Non-waterproof tape |
32 |
28 |
$8.62 |