| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
3,236 |
2,618 |
$649K |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,184 |
924 |
$439K |
| E0466 |
Home vent non-invasive inter |
630 |
506 |
$349K |
| E1390 |
Oxygen concentrator |
4,090 |
3,641 |
$263K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,449 |
1,172 |
$197K |
| B4149 |
Ef blenderized foods |
577 |
447 |
$176K |
| B4088 |
Gastro/jejuno tube, low-pro |
2,128 |
1,719 |
$125K |
| B9002 |
Enter nutr inf pump any type |
1,440 |
1,257 |
$97K |
| E0601 |
Cont airway pressure device |
2,227 |
1,944 |
$74K |
| E0445 |
Oximeter non-invasive |
509 |
411 |
$67K |
| T4534 |
Youth size pull-on |
487 |
398 |
$62K |
| A4335 |
Incontinence supply |
2,353 |
2,008 |
$59K |
| T4541 |
Large disposable underpad |
845 |
712 |
$49K |
| T4526 |
Adult size pull-on med |
247 |
207 |
$36K |
| T4528 |
Adult size pull-on xl |
374 |
304 |
$34K |
| A7030 |
Cpap full face mask |
503 |
445 |
$31K |
| E0470 |
Rad w/o backup non-inv intfc |
329 |
300 |
$31K |
| E0431 |
Portable gaseous 02 |
2,422 |
2,177 |
$28K |
| E0562 |
Humidifier heated used w pap |
2,416 |
2,142 |
$28K |
| K0001 |
Standard wheelchair |
1,285 |
1,161 |
$26K |
| T4535 |
Disposable liner/shield/pad |
377 |
303 |
$25K |
| A4604 |
Tubing with heating element |
1,031 |
913 |
$25K |
| T4527 |
Adult size pull-on lg |
214 |
177 |
$24K |
| E0465 |
Home vent invasive interface |
45 |
26 |
$22K |
| A4627 |
Spacer bag/reservoir |
1,825 |
1,703 |
$22K |
| A7031 |
Replacement facemask interfa |
659 |
611 |
$21K |
| B4150 |
Ef complet w/intact nutrient |
197 |
155 |
$17K |
| A4606 |
Oxygen probe used w oximeter |
129 |
99 |
$15K |
| B4036 |
Enteral feed sup kit grav by |
168 |
127 |
$15K |
| A4927 |
Non-sterile gloves |
952 |
728 |
$14K |
| A7035 |
Pos airway press headgear |
828 |
733 |
$11K |
| E0776 |
Iv pole |
1,046 |
927 |
$9K |
| E0570 |
Nebulizer with compression |
132 |
124 |
$8K |
| B4100 |
Food thickener oral |
30 |
24 |
$8K |
| A7038 |
Pos airway pressure filter |
1,303 |
1,121 |
$6K |
| T4530 |
Ped size brief/diaper lg |
35 |
27 |
$5K |
| E0600 |
Suction pump portab hom modl |
176 |
141 |
$4K |
| E0143 |
Walker folding wheeled w/o s |
115 |
97 |
$4K |
| E0114 |
Crutch underarm pair no wood |
134 |
128 |
$4K |
| E1392 |
Portable oxygen concentrator |
182 |
170 |
$3K |
| A7046 |
Repl water chamber, pap dev |
506 |
446 |
$3K |
| A4357 |
Bedside drainage bag |
278 |
234 |
$3K |
| B4152 |
Ef calorie dense>/=1.5kcal |
32 |
25 |
$3K |
| B4103 |
Ef ped fluid and electrolyte |
16 |
12 |
$2K |
| B9998 |
Enteral supp not otherwise c |
142 |
106 |
$2K |
| A7003 |
Nebulizer administration set |
452 |
417 |
$1K |
| T4521 |
Adult size brief/diaper sm |
15 |
12 |
$1K |
| A4213 |
20+ cc syringe only |
101 |
91 |
$1K |
| E0990 |
Wheelchair elevating leg res |
103 |
92 |
$891.54 |
| A7034 |
Nasal application device |
15 |
13 |
$811.83 |
| T4542 |
Small disposable underpad |
14 |
13 |
$655.19 |
| A7000 |
Disposable canister for pump |
31 |
26 |
$557.81 |
| E0971 |
Wheelchair anti-tipping devi |
72 |
64 |
$394.12 |
| A7015 |
Aerosol mask used w nebulize |
257 |
241 |
$346.74 |
| A4657 |
Syringe w/wo needle |
92 |
56 |
$189.37 |
| A7002 |
Tubing used w suction pump |
20 |
13 |
$134.99 |
| A4520 |
Incontinence garment anytype |
75 |
57 |
$0.00 |
| A9270 |
Non-covered item or service |
398 |
311 |
$0.00 |