| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
3,484 |
3,051 |
$1.04M |
| A4520 |
Incontinence garment anytype |
7,966 |
7,349 |
$789K |
| E1390 |
Oxygen concentrator |
7,342 |
6,909 |
$322K |
| L4387 |
Non-pneum walk boot pre ots |
1,941 |
1,843 |
$246K |
| A7030 |
Cpap full face mask |
2,492 |
2,347 |
$215K |
| B4161 |
Ef ped hydrolyzed/amino acid |
299 |
241 |
$210K |
| A4351 |
Straight tip urine catheter |
1,240 |
1,101 |
$182K |
| E0603 |
Electric breast pump |
1,328 |
1,216 |
$181K |
| E0601 |
Cont airway pressure device |
4,674 |
4,306 |
$175K |
| L3908 |
Who cock-up nonmolde pre ots |
3,218 |
2,918 |
$142K |
| A7031 |
Replacement facemask interfa |
4,695 |
4,388 |
$140K |
| A4604 |
Tubing with heating element |
4,403 |
4,133 |
$123K |
| E0570 |
Nebulizer with compression |
1,173 |
1,068 |
$84K |
| E1392 |
Portable oxygen concentrator |
4,334 |
4,104 |
$83K |
| E0470 |
Rad w/o backup non-inv intfc |
554 |
514 |
$65K |
| E0562 |
Humidifier heated used w pap |
5,241 |
4,841 |
$60K |
| B9002 |
Enter nutr inf pump any type |
635 |
573 |
$58K |
| E0114 |
Crutch underarm pair no wood |
1,428 |
1,338 |
$56K |
| A7035 |
Pos airway press headgear |
3,551 |
3,343 |
$50K |
| E0143 |
Walker folding wheeled w/o s |
1,105 |
1,063 |
$47K |
| A4554 |
Disposable underpads |
1,645 |
1,553 |
$43K |
| B4149 |
Ef blenderized foods |
152 |
95 |
$36K |
| T4541 |
Large disposable underpad |
896 |
819 |
$33K |
| A4385 |
Ost skn barrier sld ext wear |
404 |
376 |
$32K |
| B4153 |
Ef hydrolyzed/amino acids |
56 |
38 |
$31K |
| K0001 |
Standard wheelchair |
1,678 |
1,554 |
$26K |
| A7038 |
Pos airway pressure filter |
7,573 |
7,085 |
$24K |
| T4526 |
Adult size pull-on med |
266 |
237 |
$22K |
| E0118 |
Crutch substitute |
784 |
729 |
$21K |
| A4629 |
Tracheostomy care kit |
182 |
156 |
$18K |
| T4534 |
Youth size pull-on |
158 |
146 |
$18K |
| A7046 |
Repl water chamber, pap dev |
1,612 |
1,532 |
$16K |
| B4088 |
Gastro/jejuno tube, low-pro |
568 |
510 |
$16K |
| A7034 |
Nasal application device |
214 |
205 |
$14K |
| A4927 |
Non-sterile gloves |
642 |
541 |
$11K |
| T4527 |
Adult size pull-on lg |
120 |
105 |
$10K |
| A7032 |
Replacement nasal cushion |
266 |
259 |
$9K |
| E0431 |
Portable gaseous 02 |
946 |
886 |
$9K |
| E0776 |
Iv pole |
929 |
827 |
$9K |
| L3260 |
Ambulatory surgical boot eac |
587 |
547 |
$8K |
| E0250 |
Hosp bed fixed ht w/ mattres |
256 |
237 |
$7K |
| L1902 |
Afo ankle gauntlet pre ots |
135 |
130 |
$7K |
| A4565 |
Slings |
979 |
884 |
$7K |
| L4361 |
Pneuma/vac walk boot pre ots |
28 |
27 |
$7K |
| A7003 |
Nebulizer administration set |
1,381 |
1,295 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
200 |
154 |
$5K |
| A7001 |
Nondisposable pump canister |
231 |
220 |
$5K |
| A4357 |
Bedside drainage bag |
621 |
552 |
$4K |
| A4627 |
Spacer bag/reservoir |
237 |
227 |
$4K |
| B9998 |
Enteral supp not otherwise c |
331 |
253 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
444 |
387 |
$4K |
| K0003 |
Lightweight wheelchair |
84 |
81 |
$4K |
| A4358 |
Urinary leg or abdomen bag |
615 |
551 |
$4K |
| A4213 |
20+ cc syringe only |
327 |
257 |
$3K |
| E0445 |
Oximeter non-invasive |
35 |
32 |
$3K |
| E0600 |
Suction pump portab hom modl |
83 |
80 |
$3K |
| A7002 |
Tubing used w suction pump |
589 |
502 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
126 |
95 |
$2K |
| A4322 |
Irrigation syringe |
122 |
102 |
$2K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
13 |
12 |
$2K |
| K0195 |
Elevating whlchair leg rests |
266 |
224 |
$2K |
| A5500 |
Diab shoe for density insert |
22 |
17 |
$2K |
| L2999 |
Lower extremity orthosis nos |
14 |
12 |
$2K |
| L2840 |
Tibial length sock fx or equ |
35 |
28 |
$2K |
| K0108 |
W/c component-accessory nos |
31 |
14 |
$2K |
| A4628 |
Oropharyngeal suction cath |
68 |
64 |
$2K |
| L2275 |
Plastic mod low ext pad/line |
15 |
14 |
$2K |
| A6530 |
Compression stocking bk18-30 |
32 |
28 |
$2K |
| A7526 |
Tracheostomy tube collar |
46 |
36 |
$1K |
| A4624 |
Tracheal suction tube |
14 |
13 |
$1K |
| A4606 |
Oxygen probe used w oximeter |
56 |
51 |
$1K |
| T2029 |
Special med equip, noswaiver |
16 |
12 |
$1K |
| A4402 |
Lubricant per ounce |
266 |
245 |
$1K |
| A4409 |
Ost skn barr convex <=4 sq i |
14 |
13 |
$992.87 |
| T4535 |
Disposable liner/shield/pad |
13 |
12 |
$956.38 |
| L1810 |
Ko elastic with joints |
14 |
13 |
$881.95 |
| A4338 |
Indwelling catheter latex |
74 |
62 |
$679.65 |
| L3040 |
Ft arch suprt premold longit |
15 |
12 |
$367.23 |
| A7037 |
Pos airway pressure tubing |
44 |
42 |
$355.75 |
| A4467 |
Belt strap sleev grmnt cover |
12 |
12 |
$296.18 |
| A9999 |
Dme supply or accessory, nos |
57 |
26 |
$176.40 |
| A4616 |
Tubing (oxygen) per foot |
116 |
83 |
$166.05 |
| E1399 |
Durable medical equipment mi |
73 |
51 |
$114.87 |
| A4615 |
Cannula nasal |
160 |
123 |
$103.63 |
| A4657 |
Syringe w/wo needle |
120 |
94 |
$99.13 |
| E0156 |
Walker seat attachment |
14 |
13 |
$77.40 |
| A4310 |
Insert tray w/o bag/cath |
32 |
26 |
$43.91 |
| A4617 |
Mouth piece |
14 |
12 |
$43.44 |
| A7015 |
Aerosol mask used w nebulize |
14 |
12 |
$25.03 |
| A9270 |
Non-covered item or service |
15 |
12 |
$0.00 |