| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home vent invasive interface |
3,244 |
1,994 |
$1.71M |
| E1390 |
Oxygen concentrator |
20,627 |
20,003 |
$1.27M |
| E0603 |
Electric breast pump |
5,171 |
5,066 |
$1.13M |
| E0466 |
Home vent non-invasive inter |
1,022 |
950 |
$805K |
| A4217 |
Sterile water/saline, 500 ml |
3,284 |
2,836 |
$485K |
| T2029 |
Special med equip, noswaiver |
2,371 |
2,122 |
$477K |
| A4624 |
Tracheal suction tube |
1,696 |
1,506 |
$297K |
| T4541 |
Large disposable underpad |
5,548 |
5,289 |
$282K |
| K0001 |
Standard wheelchair |
11,926 |
11,561 |
$232K |
| E1392 |
Portable oxygen concentrator |
7,565 |
7,398 |
$227K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,885 |
3,737 |
$223K |
| A4606 |
Oxygen probe used w oximeter |
1,511 |
1,232 |
$199K |
| T4523 |
Adult size brief/diaper lg |
1,175 |
1,123 |
$191K |
| T4535 |
Disposable liner/shield/pad |
2,524 |
2,428 |
$171K |
| K0738 |
Portable gas oxygen system |
6,199 |
6,079 |
$170K |
| A4927 |
Non-sterile gloves |
5,310 |
4,984 |
$162K |
| E0114 |
Crutch underarm pair no wood |
2,948 |
2,902 |
$137K |
| S8189 |
Trach supply noc |
7,782 |
2,933 |
$136K |
| T4527 |
Adult size pull-on lg |
1,348 |
1,272 |
$135K |
| E0570 |
Nebulizer with compression |
5,624 |
5,489 |
$134K |
| A7521 |
Trach/laryn tube cuffed |
2,046 |
1,789 |
$131K |
| A4629 |
Tracheostomy care kit |
1,966 |
1,836 |
$122K |
| B4035 |
Enteral feed supp pump per d |
985 |
759 |
$122K |
| A7030 |
Cpap full face mask |
1,038 |
1,021 |
$99K |
| T4526 |
Adult size pull-on med |
981 |
943 |
$93K |
| A4605 |
Trach suction cath close sys |
344 |
316 |
$81K |
| A4623 |
Tracheostomy inner cannula |
355 |
328 |
$80K |
| A4604 |
Tubing with heating element |
1,888 |
1,871 |
$78K |
| T4528 |
Adult size pull-on xl |
641 |
626 |
$77K |
| B4150 |
Ef complet w/intact nutrient |
541 |
467 |
$76K |
| E0143 |
Walker folding wheeled w/o s |
1,423 |
1,369 |
$72K |
| A7526 |
Tracheostomy tube collar |
1,280 |
1,205 |
$61K |
| B4152 |
Ef calorie dense>/=1.5kcal |
353 |
295 |
$59K |
| T4522 |
Adult size brief/diaper med |
377 |
351 |
$55K |
| A7034 |
Nasal application device |
745 |
743 |
$48K |
| A9999 |
Dme supply or accessory, nos |
4,498 |
2,432 |
$47K |
| E0630 |
Patient lift hydraulic |
912 |
880 |
$41K |
| A7031 |
Replacement facemask interfa |
903 |
876 |
$35K |
| E0550 |
Humidif extens supple w ippb |
924 |
887 |
$34K |
| A7000 |
Disposable canister for pump |
2,129 |
1,985 |
$31K |
| A7035 |
Pos airway press headgear |
1,413 |
1,402 |
$30K |
| A4216 |
Sterile water/saline, 10 ml |
925 |
836 |
$27K |
| A7003 |
Nebulizer administration set |
4,943 |
4,548 |
$22K |
| E0600 |
Suction pump portab hom modl |
737 |
691 |
$21K |
| A4357 |
Bedside drainage bag |
973 |
920 |
$20K |
| E0635 |
Patient lift electric |
235 |
218 |
$20K |
| A6402 |
Sterile gauze <= 16 sq in |
1,948 |
1,753 |
$18K |
| A4628 |
Oropharyngeal suction cath |
877 |
788 |
$17K |
| A7038 |
Pos airway pressure filter |
3,100 |
3,048 |
$17K |
| T4534 |
Youth size pull-on |
147 |
130 |
$17K |
| A4670 |
Automatic bp monitor, dial |
235 |
231 |
$17K |
| A4351 |
Straight tip urine catheter |
76 |
75 |
$16K |
| A7520 |
Trach/laryn tube non-cuffed |
217 |
187 |
$15K |
| A7507 |
Integrated filter & holder |
261 |
221 |
$15K |
| A7002 |
Tubing used w suction pump |
2,399 |
2,091 |
$14K |
| K0195 |
Elevating whlchair leg rests |
1,218 |
1,185 |
$14K |
| A7032 |
Replacement nasal cushion |
362 |
359 |
$14K |
| A7046 |
Repl water chamber, pap dev |
900 |
890 |
$12K |
| A4213 |
20+ cc syringe only |
625 |
580 |
$12K |
| T4524 |
Adult size brief/diaper xl |
68 |
64 |
$10K |
| E0439 |
Stationary liquid 02 |
162 |
160 |
$10K |
| E0431 |
Portable gaseous 02 |
559 |
551 |
$9K |
| A4245 |
Alcohol wipes per box |
737 |
702 |
$7K |
| A4452 |
Waterproof tape |
266 |
240 |
$5K |
| B4034 |
Enter feed supkit syr by day |
80 |
67 |
$5K |
| A7509 |
Heat & moisture exchange sys |
302 |
272 |
$5K |
| E2601 |
Gen w/c cushion wdth < 22 in |
136 |
127 |
$5K |
| E0601 |
Cont airway pressure device |
347 |
336 |
$4K |
| A7039 |
Filter, non disposable w pap |
407 |
402 |
$3K |
| A4310 |
Insert tray w/o bag/cath |
277 |
258 |
$3K |
| B9998 |
Enteral supp not otherwise c |
116 |
67 |
$2K |
| E0118 |
Crutch substitute |
40 |
40 |
$2K |
| A7525 |
Tracheostomy mask |
376 |
336 |
$2K |
| A4244 |
Alcohol or peroxide per pint |
484 |
464 |
$2K |
| E0149 |
Heavy duty wheeled walker |
48 |
48 |
$2K |
| B4088 |
Gastro/jejuno tube, low-pro |
46 |
38 |
$2K |
| A4618 |
Breathing circuits |
116 |
99 |
$1K |
| A7033 |
Replacement nasal pillows |
43 |
42 |
$1K |
| A4450 |
Non-waterproof tape |
348 |
334 |
$1K |
| T4525 |
Adult size pull-on sm |
14 |
13 |
$1K |
| K0006 |
Heavy duty wheelchair |
26 |
24 |
$1K |
| E1399 |
Durable medical equipment mi |
1,193 |
555 |
$1K |
| S8186 |
Swivel adaptor |
119 |
119 |
$1K |
| A4657 |
Syringe w/wo needle |
716 |
655 |
$1K |
| A4320 |
Irrigation tray |
15 |
12 |
$991.49 |
| A4344 |
Cath indw foley 2 way silicn |
26 |
24 |
$418.15 |
| A4520 |
Incontinence garment anytype |
14 |
12 |
$397.05 |
| A6216 |
Non-sterile gauze<=16 sq in |
40 |
38 |
$250.28 |
| A7013 |
Disposable compressor filter |
353 |
337 |
$228.79 |
| A7037 |
Pos airway pressure tubing |
13 |
13 |
$228.29 |
| A4332 |
Lube sterile packet |
12 |
12 |
$126.81 |
| A4649 |
Surgical supplies |
13 |
12 |
$32.83 |
| A4554 |
Disposable underpads |
16 |
13 |
$0.00 |
| A9270 |
Non-covered item or service |
118 |
116 |
$0.00 |