| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,656 |
1,495 |
$2.96M |
| A9900 |
Supply/accessory/service |
10,651 |
6,606 |
$2.29M |
| E1390 |
Oxygen concentrator |
22,003 |
19,038 |
$1.96M |
| B4161 |
Ef ped hydrolyzed/amino acid |
2,388 |
1,873 |
$1.89M |
| B4035 |
Enteral feed supp pump per d |
9,846 |
8,715 |
$1.78M |
| B9998 |
Enteral supp not otherwise c |
9,306 |
8,299 |
$1.27M |
| A4624 |
Tracheal suction tube |
3,779 |
3,206 |
$1.16M |
| E0466 |
Home vent non-invasive inter |
1,890 |
1,732 |
$915K |
| B9002 |
Enter nutr inf pump any type |
11,333 |
11,011 |
$894K |
| E0465 |
Home vent invasive interface |
1,371 |
1,246 |
$869K |
| E0570 |
Nebulizer with compression |
15,442 |
13,782 |
$866K |
| E0445 |
Oximeter non-invasive |
9,985 |
9,599 |
$685K |
| E0431 |
Portable gaseous 02 |
20,931 |
18,196 |
$495K |
| K0001 |
Standard wheelchair |
21,965 |
19,123 |
$437K |
| B4088 |
Gastro/jejuno tube, low-pro |
5,347 |
4,980 |
$420K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,957 |
1,732 |
$409K |
| E0619 |
Apnea monitor w recorder |
2,236 |
2,056 |
$319K |
| B4034 |
Enter feed supkit syr by day |
3,087 |
2,737 |
$302K |
| A4208 |
3 cc sterile syringe&needle |
2,291 |
2,001 |
$273K |
| A4216 |
Sterile water/saline, 10 ml |
4,472 |
3,773 |
$236K |
| A4209 |
5+ cc sterile syringe&needle |
4,732 |
4,236 |
$235K |
| E0255 |
Hospital bed var ht w/ mattr |
3,058 |
2,940 |
$209K |
| E0143 |
Walker folding wheeled w/o s |
4,138 |
3,758 |
$208K |
| B4149 |
Ef blenderized foods |
534 |
473 |
$205K |
| A4629 |
Tracheostomy care kit |
3,267 |
2,768 |
$204K |
| A4606 |
Oxygen probe used w oximeter |
1,191 |
1,098 |
$202K |
| E0601 |
Cont airway pressure device |
4,310 |
3,984 |
$179K |
| A4206 |
1 cc sterile syringe&needle |
1,774 |
1,577 |
$163K |
| B4150 |
Ef complet w/intact nutrient |
1,014 |
857 |
$159K |
| E0600 |
Suction pump portab hom modl |
5,182 |
4,967 |
$154K |
| A7508 |
Housing & integrated adhesiv |
3,358 |
2,832 |
$152K |
| E0603 |
Electric breast pump |
1,614 |
1,585 |
$151K |
| A4554 |
Disposable underpads |
3,640 |
3,208 |
$141K |
| A4450 |
Non-waterproof tape |
2,987 |
2,553 |
$138K |
| A7003 |
Nebulizer administration set |
14,501 |
13,518 |
$137K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
1,194 |
1,083 |
$119K |
| A4322 |
Irrigation syringe |
4,065 |
3,667 |
$112K |
| A4217 |
Sterile water/saline, 500 ml |
3,784 |
3,348 |
$110K |
| B4152 |
Ef calorie dense>/=1.5kcal |
641 |
555 |
$103K |
| A4927 |
Non-sterile gloves |
6,077 |
5,500 |
$100K |
| B4153 |
Ef hydrolyzed/amino acids |
115 |
100 |
$91K |
| A6402 |
Sterile gauze <= 16 sq in |
6,315 |
5,555 |
$85K |
| E0260 |
Hosp bed semi-electr w/ matt |
6,279 |
3,880 |
$84K |
| A7000 |
Disposable canister for pump |
6,095 |
5,327 |
$74K |
| E0562 |
Humidifier heated used w pap |
7,575 |
7,192 |
$72K |
| E0470 |
Rad w/o backup non-inv intfc |
602 |
570 |
$70K |
| E0163 |
Commode chair with fixed arm |
1,840 |
1,690 |
$67K |
| K0195 |
Elevating whlchair leg rests |
15,883 |
12,940 |
$66K |
| A7526 |
Tracheostomy tube collar |
3,882 |
3,333 |
$64K |
| T4529 |
Ped size brief/diaper sm/med |
934 |
826 |
$63K |
| E0630 |
Patient lift hydraulic |
2,453 |
1,903 |
$63K |
| E0240 |
Bath/shower chair |
207 |
167 |
$57K |
| T4534 |
Youth size pull-on |
414 |
390 |
$52K |
| K0006 |
Heavy duty wheelchair |
944 |
872 |
$50K |
| A7520 |
Trach/laryn tube non-cuffed |
1,396 |
1,203 |
$46K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
724 |
634 |
$45K |
| E0776 |
Iv pole |
5,276 |
5,105 |
$44K |
| A4245 |
Alcohol wipes per box |
3,509 |
3,077 |
$42K |
| A4213 |
20+ cc syringe only |
917 |
825 |
$41K |
| A7002 |
Tubing used w suction pump |
6,366 |
5,561 |
$38K |
| L8501 |
Tracheostomy speaking valve |
361 |
335 |
$34K |
| A7014 |
Compressor nondispos filter |
6,006 |
5,266 |
$34K |
| A6216 |
Non-sterile gauze<=16 sq in |
3,340 |
2,853 |
$34K |
| T4522 |
Adult size brief/diaper med |
417 |
360 |
$33K |
| A4371 |
Skin barrier powder per oz |
1,232 |
1,061 |
$27K |
| K0003 |
Lightweight wheelchair |
1,891 |
1,769 |
$25K |
| A4332 |
Lube sterile packet |
1,974 |
1,675 |
$23K |
| E1236 |
Folding ped wc adjustable |
38 |
37 |
$21K |
| A4605 |
Trach suction cath close sys |
1,235 |
1,061 |
$21K |
| A6257 |
Transparent film <= 16 sq in |
774 |
673 |
$20K |
| A4244 |
Alcohol or peroxide per pint |
3,133 |
2,727 |
$20K |
| A4369 |
Skin barrier liquid per oz |
1,183 |
1,011 |
$17K |
| A4452 |
Waterproof tape |
613 |
552 |
$15K |
| E0565 |
Compressor air power source |
802 |
795 |
$15K |
| E0156 |
Walker seat attachment |
2,083 |
1,800 |
$15K |
| E1392 |
Portable oxygen concentrator |
337 |
321 |
$14K |
| T4525 |
Adult size pull-on sm |
127 |
115 |
$13K |
| B4155 |
Ef incomplete/modular |
190 |
180 |
$13K |
| A4456 |
Adhesive remover, wipes |
1,097 |
931 |
$12K |
| A7015 |
Aerosol mask used w nebulize |
8,654 |
8,327 |
$10K |
| A7525 |
Tracheostomy mask |
2,161 |
1,744 |
$9K |
| A4628 |
Oropharyngeal suction cath |
192 |
164 |
$8K |
| E0973 |
W/ch access det adj armrest |
712 |
504 |
$8K |
| A6457 |
Tubular dressing |
420 |
363 |
$8K |
| A7046 |
Repl water chamber, pap dev |
287 |
211 |
$7K |
| A4627 |
Spacer bag/reservoir |
354 |
296 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
1,183 |
834 |
$5K |
| E0250 |
Hosp bed fixed ht w/ mattres |
113 |
109 |
$5K |
| A7010 |
Disposable corrugated tubing |
411 |
355 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
1,075 |
777 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
487 |
394 |
$2K |
| K0004 |
High strength ltwt whlchr |
851 |
724 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
341 |
296 |
$2K |
| A4455 |
Adhesive remover per ounce |
130 |
117 |
$2K |
| E0185 |
Gel pressure mattress pad |
86 |
58 |
$2K |
| E1226 |
Manual fully reclining back |
134 |
117 |
$2K |
| A4623 |
Tracheostomy inner cannula |
85 |
67 |
$1K |
| A7005 |
Nondisposable nebulizer set |
73 |
57 |
$1K |
| T4526 |
Adult size pull-on med |
22 |
14 |
$1K |
| E0550 |
Humidif extens supple w ippb |
26 |
25 |
$1K |
| A7007 |
Lg vol nebulizer disposable |
208 |
173 |
$785.49 |
| K0800 |
Pov group 1 std up to 300lbs |
15 |
12 |
$652.67 |
| A4335 |
Incontinence supply |
71 |
66 |
$590.37 |
| A7034 |
Nasal application device |
36 |
24 |
$525.21 |
| A7012 |
Nebulizer water collec devic |
229 |
194 |
$371.35 |
| A7038 |
Pos airway pressure filter |
145 |
89 |
$197.30 |
| A7030 |
Cpap full face mask |
20 |
12 |
$193.24 |
| A6250 |
Skin seal protect moisturizr |
15 |
14 |
$176.82 |
| A6449 |
Lt compres band >=3" <5"/yd |
12 |
12 |
$162.12 |
| E0100 |
Cane adjust/fixed with tip |
14 |
13 |
$156.17 |
| A7037 |
Pos airway pressure tubing |
142 |
95 |
$96.75 |
| E1038 |
Transport chair pt wt<=300lb |
24 |
24 |
$0.00 |
| A6258 |
Transparent film >16<=48 in |
33 |
26 |
$0.00 |
| A7039 |
Filter, non disposable w pap |
25 |
16 |
$0.00 |