| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
1,288 |
942 |
$238K |
| T4535 |
Disposable liner/shield/pad |
6,531 |
5,350 |
$222K |
| E0601 |
Cont airway pressure device |
5,777 |
5,051 |
$171K |
| B4150 |
Ef complet w/intact nutrient |
3,197 |
1,998 |
$165K |
| E1390 |
Oxygen concentrator |
3,820 |
3,388 |
$157K |
| L4361 |
Pneuma/vac walk boot pre ots |
741 |
675 |
$126K |
| T4522 |
Adult size brief/diaper med |
1,119 |
848 |
$112K |
| T4526 |
Adult size pull-on med |
2,410 |
1,999 |
$106K |
| T4527 |
Adult size pull-on lg |
1,793 |
1,499 |
$100K |
| T4541 |
Large disposable underpad |
2,423 |
2,085 |
$97K |
| B9998 |
Enteral supp not otherwise c |
1,756 |
929 |
$96K |
| T2029 |
Special med equip, noswaiver |
2,631 |
1,409 |
$87K |
| T4534 |
Youth size pull-on |
1,162 |
881 |
$83K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,197 |
2,017 |
$83K |
| E0570 |
Nebulizer with compression |
6,280 |
5,574 |
$71K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,151 |
577 |
$70K |
| A4927 |
Non-sterile gloves |
3,222 |
2,729 |
$59K |
| T4528 |
Adult size pull-on xl |
1,029 |
861 |
$56K |
| T4523 |
Adult size brief/diaper lg |
443 |
344 |
$52K |
| L3908 |
Who cock-up nonmolde pre ots |
1,622 |
1,294 |
$52K |
| E0114 |
Crutch underarm pair no wood |
1,546 |
1,392 |
$42K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
383 |
171 |
$42K |
| E0562 |
Humidifier heated used w pap |
2,537 |
2,136 |
$35K |
| S5161 |
Emer rspns sys serv permonth |
2,852 |
2,336 |
$33K |
| A4604 |
Tubing with heating element |
1,104 |
1,027 |
$33K |
| E1399 |
Durable medical equipment mi |
577 |
179 |
$29K |
| K0001 |
Standard wheelchair |
1,581 |
1,402 |
$26K |
| L1833 |
Ko adj jnt pos r sup pre ots |
190 |
170 |
$23K |
| A7035 |
Pos airway press headgear |
1,109 |
1,010 |
$18K |
| E0143 |
Walker folding wheeled w/o s |
918 |
806 |
$17K |
| E0603 |
Electric breast pump |
169 |
142 |
$17K |
| L1820 |
Ko elas w/ condyle pads & jo |
303 |
242 |
$16K |
| K0003 |
Lightweight wheelchair |
686 |
606 |
$12K |
| A7038 |
Pos airway pressure filter |
3,064 |
2,782 |
$11K |
| A4351 |
Straight tip urine catheter |
123 |
88 |
$11K |
| L1902 |
Afo ankle gauntlet pre ots |
345 |
294 |
$9K |
| A7034 |
Nasal application device |
190 |
179 |
$9K |
| T4521 |
Adult size brief/diaper sm |
91 |
61 |
$7K |
| E0265 |
Hosp bed total electr w/ mat |
77 |
77 |
$5K |
| A4629 |
Tracheostomy care kit |
42 |
38 |
$4K |
| A7003 |
Nebulizer administration set |
1,180 |
931 |
$4K |
| K0739 |
Repair/svc dme non-oxygen eq |
254 |
198 |
$3K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
186 |
176 |
$3K |
| E1392 |
Portable oxygen concentrator |
198 |
157 |
$2K |
| L3807 |
Whfo w/o joints pre cst |
38 |
36 |
$2K |
| A7000 |
Disposable canister for pump |
133 |
118 |
$2K |
| A4385 |
Ost skn barrier sld ext wear |
82 |
75 |
$2K |
| A4628 |
Oropharyngeal suction cath |
105 |
92 |
$2K |
| A7033 |
Replacement nasal pillows |
100 |
88 |
$2K |
| A4452 |
Waterproof tape |
142 |
109 |
$2K |
| A7002 |
Tubing used w suction pump |
261 |
214 |
$1K |
| B4152 |
Ef calorie dense>/=1.5kcal |
19 |
12 |
$1K |
| L4387 |
Non-pneum walk boot pre ots |
13 |
12 |
$1K |
| K0738 |
Portable gas oxygen system |
258 |
245 |
$1K |
| A4357 |
Bedside drainage bag |
84 |
74 |
$863.92 |
| K0004 |
High strength ltwt whlchr |
13 |
13 |
$797.70 |
| B9002 |
Enter nutr inf pump any type |
18 |
12 |
$771.14 |
| A7031 |
Replacement facemask interfa |
27 |
27 |
$767.37 |
| E0118 |
Crutch substitute |
101 |
93 |
$743.20 |
| E0600 |
Suction pump portab hom modl |
24 |
24 |
$701.63 |
| A7032 |
Replacement nasal cushion |
39 |
38 |
$679.10 |
| K0195 |
Elevating whlchair leg rests |
112 |
109 |
$544.39 |
| A4618 |
Breathing circuits |
38 |
25 |
$426.86 |
| A5063 |
Drain ostomy pouch w/flange |
14 |
13 |
$366.05 |
| E0431 |
Portable gaseous 02 |
48 |
39 |
$342.03 |
| E0971 |
Wheelchair anti-tipping devi |
19 |
14 |
$252.90 |
| A7037 |
Pos airway pressure tubing |
13 |
13 |
$199.54 |
| L3040 |
Ft arch suprt premold longit |
40 |
26 |
$166.00 |
| A6402 |
Sterile gauze <= 16 sq in |
13 |
12 |
$139.18 |
| E0250 |
Hosp bed fixed ht w/ mattres |
13 |
13 |
$132.05 |
| A7046 |
Repl water chamber, pap dev |
31 |
26 |
$124.54 |
| S8189 |
Trach supply noc |
24 |
13 |
$103.25 |
| A4565 |
Slings |
15 |
14 |
$101.72 |
| E0156 |
Walker seat attachment |
14 |
14 |
$0.00 |