| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
5,270 |
5,142 |
$4.51M |
| E0570 |
Nebulizer with compression |
45,462 |
45,257 |
$4.47M |
| B4035 |
Enteral feed supp pump per d |
16,613 |
14,977 |
$4.41M |
| E0465 |
Home vent invasive interface |
4,999 |
4,450 |
$4.12M |
| B9998 |
Enteral supp not otherwise c |
23,235 |
17,021 |
$2.90M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,536 |
6,394 |
$2.03M |
| E1390 |
Oxygen concentrator |
12,087 |
11,919 |
$1.49M |
| B4149 |
Ef blenderized foods |
3,491 |
3,398 |
$1.44M |
| A4606 |
Oxygen probe used w oximeter |
13,258 |
9,905 |
$1.14M |
| B4153 |
Ef hydrolyzed/amino acids |
633 |
606 |
$1.00M |
| E0466 |
Home vent non-invasive inter |
1,088 |
1,052 |
$859K |
| A7005 |
Nondisposable nebulizer set |
51,132 |
50,693 |
$838K |
| A4624 |
Tracheal suction tube |
5,866 |
5,258 |
$801K |
| A4353 |
Intermittent urinary cath |
1,465 |
1,333 |
$765K |
| A4554 |
Disposable underpads |
23,932 |
22,960 |
$745K |
| B4104 |
Additive for enteral formula |
1,986 |
1,935 |
$745K |
| B4155 |
Ef incomplete/modular |
2,745 |
2,620 |
$742K |
| E0482 |
Cough stimulating device |
2,996 |
2,891 |
$709K |
| A4627 |
Spacer bag/reservoir |
28,519 |
27,955 |
$687K |
| B4150 |
Ef complet w/intact nutrient |
2,058 |
1,943 |
$687K |
| S8101 |
Spacer with mask |
29,084 |
28,487 |
$673K |
| T4530 |
Ped size brief/diaper lg |
6,576 |
6,163 |
$563K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
3,591 |
2,894 |
$541K |
| T4534 |
Youth size pull-on |
5,145 |
4,902 |
$506K |
| A4629 |
Tracheostomy care kit |
5,134 |
4,849 |
$502K |
| A4605 |
Trach suction cath close sys |
3,312 |
2,938 |
$459K |
| E0445 |
Oximeter non-invasive |
2,668 |
2,620 |
$431K |
| B9002 |
Enter nutr inf pump any type |
4,275 |
4,234 |
$420K |
| T4522 |
Adult size brief/diaper med |
4,008 |
3,893 |
$397K |
| A7000 |
Disposable canister for pump |
13,744 |
12,531 |
$340K |
| B4152 |
Ef calorie dense>/=1.5kcal |
782 |
755 |
$339K |
| A6212 |
Foam drg <=16 sq in w/border |
1,539 |
1,302 |
$313K |
| T4532 |
Ped size pull-on lg |
2,352 |
2,265 |
$305K |
| T4521 |
Adult size brief/diaper sm |
3,253 |
3,079 |
$303K |
| A7520 |
Trach/laryn tube non-cuffed |
5,087 |
4,257 |
$266K |
| T1999 |
Noc retail items andsupplies |
28,111 |
16,608 |
$257K |
| E0431 |
Portable gaseous 02 |
11,453 |
11,326 |
$250K |
| A7002 |
Tubing used w suction pump |
12,878 |
12,397 |
$248K |
| A7526 |
Tracheostomy tube collar |
9,700 |
6,235 |
$234K |
| A4216 |
Sterile water/saline, 10 ml |
12,290 |
6,810 |
$231K |
| B4103 |
Ef ped fluid and electrolyte |
725 |
690 |
$221K |
| B4158 |
Ef ped complete intact nut |
726 |
708 |
$216K |
| E0603 |
Electric breast pump |
1,460 |
1,450 |
$211K |
| B4034 |
Enter feed supkit syr by day |
1,747 |
1,578 |
$211K |
| E0601 |
Cont airway pressure device |
2,993 |
2,956 |
$202K |
| A7521 |
Trach/laryn tube cuffed |
2,376 |
2,014 |
$144K |
| A4335 |
Incontinence supply |
26,964 |
25,648 |
$132K |
| T4526 |
Adult size pull-on med |
1,209 |
1,182 |
$130K |
| T4523 |
Adult size brief/diaper lg |
1,244 |
1,147 |
$129K |
| A4322 |
Irrigation syringe |
15,614 |
15,066 |
$125K |
| A4344 |
Cath indw foley 2 way silicn |
821 |
652 |
$124K |
| A4927 |
Non-sterile gloves |
16,338 |
14,811 |
$110K |
| E0471 |
Rad w/backup non inv intrfc |
299 |
291 |
$102K |
| A6250 |
Skin seal protect moisturizr |
5,655 |
4,650 |
$92K |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
1,140 |
1,109 |
$88K |
| A4628 |
Oropharyngeal suction cath |
13,640 |
12,687 |
$82K |
| A6216 |
Non-sterile gauze<=16 sq in |
15,815 |
13,673 |
$71K |
| A4310 |
Insert tray w/o bag/cath |
732 |
563 |
$67K |
| E0562 |
Humidifier heated used w pap |
3,871 |
3,827 |
$65K |
| A7015 |
Aerosol mask used w nebulize |
56,058 |
55,295 |
$65K |
| E0600 |
Suction pump portab hom modl |
191 |
158 |
$57K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
871 |
817 |
$53K |
| A4217 |
Sterile water/saline, 500 ml |
2,255 |
1,555 |
$43K |
| T4524 |
Adult size brief/diaper xl |
323 |
285 |
$39K |
| A6257 |
Transparent film <= 16 sq in |
1,832 |
1,693 |
$36K |
| T4527 |
Adult size pull-on lg |
278 |
270 |
$32K |
| A7003 |
Nebulizer administration set |
10,022 |
9,525 |
$31K |
| A7013 |
Disposable compressor filter |
48,851 |
48,531 |
$25K |
| B4154 |
Ef spec metabolic noninherit |
27 |
27 |
$23K |
| E0260 |
Hosp bed semi-electr w/ matt |
283 |
281 |
$23K |
| A9900 |
Supply/accessory/service |
177 |
171 |
$23K |
| E0776 |
Iv pole |
2,743 |
2,697 |
$21K |
| A4402 |
Lubricant per ounce |
3,644 |
3,435 |
$20K |
| T4535 |
Disposable liner/shield/pad |
911 |
856 |
$17K |
| A4623 |
Tracheostomy inner cannula |
387 |
355 |
$17K |
| E0470 |
Rad w/o backup non-inv intfc |
87 |
87 |
$16K |
| A7037 |
Pos airway pressure tubing |
657 |
640 |
$14K |
| A7525 |
Tracheostomy mask |
4,209 |
3,389 |
$14K |
| K0003 |
Lightweight wheelchair |
467 |
445 |
$12K |
| E0481 |
Intrpulmnry percuss vent sys |
39 |
36 |
$12K |
| A4357 |
Bedside drainage bag |
707 |
525 |
$11K |
| A4481 |
Tracheostoma filter |
1,191 |
841 |
$11K |
| A4450 |
Non-waterproof tape |
6,267 |
5,731 |
$10K |
| A7010 |
Disposable corrugated tubing |
612 |
454 |
$10K |
| A4351 |
Straight tip urine catheter |
39 |
37 |
$9K |
| S8999 |
Resuscitation bag |
69 |
64 |
$8K |
| A4670 |
Automatic bp monitor, dial |
234 |
233 |
$8K |
| A7034 |
Nasal application device |
114 |
113 |
$8K |
| B4100 |
Food thickener oral |
92 |
88 |
$8K |
| E0114 |
Crutch underarm pair no wood |
311 |
305 |
$8K |
| A7046 |
Repl water chamber, pap dev |
352 |
242 |
$5K |
| A4245 |
Alcohol wipes per box |
2,079 |
1,997 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
342 |
301 |
$3K |
| A7038 |
Pos airway pressure filter |
450 |
448 |
$2K |
| A7035 |
Pos airway press headgear |
94 |
91 |
$2K |
| E0565 |
Compressor air power source |
65 |
64 |
$2K |
| L8501 |
Tracheostomy speaking valve |
25 |
25 |
$1K |
| A7032 |
Replacement nasal cushion |
12 |
12 |
$591.55 |
| A4456 |
Adhesive remover, wipes |
67 |
24 |
$510.22 |
| A7039 |
Filter, non disposable w pap |
63 |
63 |
$422.06 |
| A5200 |
Percutaneous catheter anchor |
24 |
24 |
$347.84 |
| K0001 |
Standard wheelchair |
15 |
14 |
$261.68 |
| A4331 |
Extension drainage tubing |
16 |
12 |
$67.75 |
| A4244 |
Alcohol or peroxide per pint |
16 |
15 |
$11.90 |