| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4624 |
Tracheal suction tube |
4,389 |
3,786 |
$581K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,563 |
2,116 |
$474K |
| T4534 |
Youth size pull-on |
2,576 |
2,196 |
$421K |
| B4035 |
Enteral feed supp pump per d |
6,777 |
6,190 |
$414K |
| E0601 |
Cont airway pressure device |
8,159 |
6,201 |
$409K |
| E1390 |
Oxygen concentrator |
4,397 |
3,491 |
$256K |
| A4605 |
Trach suction cath close sys |
1,590 |
1,395 |
$249K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,618 |
3,203 |
$205K |
| A4623 |
Tracheostomy inner cannula |
3,196 |
2,809 |
$183K |
| B4150 |
Ef complet w/intact nutrient |
2,761 |
2,472 |
$162K |
| A7030 |
Cpap full face mask |
1,715 |
1,509 |
$154K |
| B9998 |
Enteral supp not otherwise c |
2,478 |
1,984 |
$126K |
| A7521 |
Trach/laryn tube cuffed |
5,287 |
4,400 |
$120K |
| A4629 |
Tracheostomy care kit |
5,389 |
4,296 |
$96K |
| A4606 |
Oxygen probe used w oximeter |
1,134 |
720 |
$94K |
| B4154 |
Ef spec metabolic noninherit |
1,308 |
1,189 |
$86K |
| A7031 |
Replacement facemask interfa |
2,342 |
2,212 |
$84K |
| E0570 |
Nebulizer with compression |
2,309 |
2,121 |
$80K |
| S8189 |
Trach supply noc |
1,310 |
821 |
$73K |
| E0562 |
Humidifier heated used w pap |
697 |
561 |
$65K |
| E0470 |
Rad w/o backup non-inv intfc |
345 |
317 |
$59K |
| A7037 |
Pos airway pressure tubing |
2,524 |
2,269 |
$58K |
| A7526 |
Tracheostomy tube collar |
5,262 |
4,572 |
$49K |
| A4483 |
Moisture exchanger |
1,630 |
1,083 |
$49K |
| A7035 |
Pos airway press headgear |
2,332 |
2,060 |
$48K |
| T4532 |
Ped size pull-on lg |
336 |
280 |
$46K |
| B4161 |
Ef ped hydrolyzed/amino acid |
71 |
62 |
$38K |
| A4322 |
Irrigation syringe |
1,590 |
1,186 |
$34K |
| A7038 |
Pos airway pressure filter |
5,118 |
4,749 |
$32K |
| A7000 |
Disposable canister for pump |
5,651 |
4,964 |
$32K |
| A6402 |
Sterile gauze <= 16 sq in |
4,820 |
4,269 |
$29K |
| E0431 |
Portable gaseous 02 |
4,693 |
3,678 |
$28K |
| B4034 |
Enter feed supkit syr by day |
1,203 |
1,110 |
$23K |
| K0001 |
Standard wheelchair |
1,763 |
1,472 |
$22K |
| A7508 |
Housing & integrated adhesiv |
1,974 |
1,650 |
$16K |
| A7002 |
Tubing used w suction pump |
4,846 |
3,981 |
$16K |
| A7039 |
Filter, non disposable w pap |
2,071 |
1,816 |
$15K |
| A4628 |
Oropharyngeal suction cath |
2,481 |
2,223 |
$15K |
| T4533 |
Youth size brief/diaper |
127 |
113 |
$14K |
| E0600 |
Suction pump portab hom modl |
554 |
405 |
$14K |
| A7003 |
Nebulizer administration set |
5,069 |
4,434 |
$13K |
| E0443 |
Portable 02 contents, gas |
726 |
633 |
$13K |
| A7046 |
Repl water chamber, pap dev |
1,508 |
1,260 |
$9K |
| A7007 |
Lg vol nebulizer disposable |
2,660 |
2,024 |
$8K |
| A7034 |
Nasal application device |
112 |
108 |
$8K |
| L8501 |
Tracheostomy speaking valve |
188 |
168 |
$8K |
| A7010 |
Disposable corrugated tubing |
988 |
888 |
$6K |
| A4618 |
Breathing circuits |
345 |
295 |
$5K |
| A7012 |
Nebulizer water collec devic |
2,027 |
1,639 |
$5K |
| B4088 |
Gastro/jejuno tube, low-pro |
774 |
725 |
$3K |
| A7525 |
Tracheostomy mask |
1,754 |
1,135 |
$2K |
| A7032 |
Replacement nasal cushion |
38 |
37 |
$2K |
| A9900 |
Supply/accessory/service |
218 |
185 |
$2K |
| S8186 |
Swivel adaptor |
368 |
262 |
$1K |
| A4616 |
Tubing (oxygen) per foot |
814 |
692 |
$676.82 |
| E0163 |
Commode chair with fixed arm |
16 |
13 |
$482.20 |
| A4927 |
Non-sterile gloves |
61 |
60 |
$458.60 |
| A4615 |
Cannula nasal |
334 |
228 |
$273.78 |
| A4557 |
Lead wires, pair |
15 |
13 |
$100.83 |
| A4217 |
Sterile water/saline, 500 ml |
49 |
38 |
$0.00 |