| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
28,369 |
25,793 |
$2.24M |
| B4161 |
Ef ped hydrolyzed/amino acid |
4,913 |
3,673 |
$2.20M |
| T1999 |
Noc retail items andsupplies |
55,735 |
52,969 |
$2.05M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
10,604 |
8,881 |
$1.98M |
| E0466 |
Home vent non-invasive inter |
3,391 |
3,062 |
$1.59M |
| T4535 |
Disposable liner/shield/pad |
25,481 |
24,566 |
$1.51M |
| T4527 |
Adult size pull-on lg |
9,287 |
8,977 |
$1.30M |
| T4541 |
Large disposable underpad |
31,786 |
30,713 |
$1.30M |
| T4526 |
Adult size pull-on med |
9,911 |
9,651 |
$1.16M |
| A9999 |
Dme supply or accessory, nos |
40,860 |
23,811 |
$1.10M |
| B4035 |
Enteral feed supp pump per d |
5,019 |
4,162 |
$1.04M |
| T4543 |
Adult disp brief/diap abv xl |
1,346 |
1,284 |
$817K |
| T4534 |
Youth size pull-on |
5,976 |
5,609 |
$797K |
| B4152 |
Ef calorie dense>/=1.5kcal |
5,835 |
4,794 |
$769K |
| E0601 |
Cont airway pressure device |
11,860 |
10,562 |
$689K |
| B4150 |
Ef complet w/intact nutrient |
5,872 |
4,631 |
$646K |
| T4528 |
Adult size pull-on xl |
4,692 |
4,534 |
$641K |
| B4158 |
Ef ped complete intact nut |
3,669 |
2,737 |
$576K |
| A7030 |
Cpap full face mask |
5,597 |
5,067 |
$567K |
| A4927 |
Non-sterile gloves |
26,810 |
24,015 |
$566K |
| E0260 |
Hosp bed semi-electr w/ matt |
8,434 |
7,305 |
$455K |
| E1392 |
Portable oxygen concentrator |
14,500 |
12,948 |
$398K |
| T4537 |
Reusable underpad bed size |
12,129 |
11,567 |
$378K |
| B4088 |
Gastro/jejuno tube, low-pro |
2,542 |
2,209 |
$352K |
| T4544 |
Adlt disp und/pull on abv xl |
1,918 |
1,878 |
$347K |
| A4604 |
Tubing with heating element |
8,596 |
7,714 |
$327K |
| E0562 |
Humidifier heated used w pap |
3,197 |
2,838 |
$320K |
| T4522 |
Adult size brief/diaper med |
2,887 |
2,703 |
$320K |
| T4523 |
Adult size brief/diaper lg |
2,507 |
2,373 |
$319K |
| A7034 |
Nasal application device |
4,795 |
4,314 |
$316K |
| E0470 |
Rad w/o backup non-inv intfc |
2,188 |
1,982 |
$301K |
| A6250 |
Skin seal protect moisturizr |
41,799 |
25,303 |
$298K |
| T4524 |
Adult size brief/diaper xl |
1,865 |
1,766 |
$283K |
| A7031 |
Replacement facemask interfa |
6,871 |
6,330 |
$278K |
| K0001 |
Standard wheelchair |
9,353 |
8,094 |
$225K |
| B4154 |
Ef spec metabolic noninherit |
1,356 |
1,174 |
$203K |
| B9002 |
Enter nutr inf pump any type |
1,345 |
991 |
$199K |
| B4034 |
Enter feed supkit syr by day |
2,017 |
1,679 |
$189K |
| B9998 |
Enteral supp not otherwise c |
2,571 |
1,359 |
$184K |
| T4525 |
Adult size pull-on sm |
1,472 |
1,443 |
$176K |
| A4624 |
Tracheal suction tube |
1,031 |
824 |
$173K |
| K0738 |
Portable gas oxygen system |
6,849 |
6,220 |
$170K |
| T4530 |
Ped size brief/diaper lg |
1,703 |
1,547 |
$165K |
| E0465 |
Home vent invasive interface |
359 |
258 |
$146K |
| A7032 |
Replacement nasal cushion |
4,873 |
4,257 |
$139K |
| B4100 |
Food thickener oral |
848 |
687 |
$132K |
| B4149 |
Ef blenderized foods |
436 |
335 |
$131K |
| A7035 |
Pos airway press headgear |
6,143 |
5,532 |
$130K |
| E0630 |
Patient lift hydraulic |
2,745 |
2,395 |
$129K |
| E0445 |
Oximeter non-invasive |
967 |
549 |
$117K |
| A4351 |
Straight tip urine catheter |
951 |
814 |
$111K |
| E0143 |
Walker folding wheeled w/o s |
2,358 |
2,077 |
$104K |
| E0570 |
Nebulizer with compression |
7,317 |
6,304 |
$104K |
| E0600 |
Suction pump portab hom modl |
1,291 |
1,063 |
$97K |
| A7038 |
Pos airway pressure filter |
14,533 |
13,277 |
$58K |
| A4213 |
20+ cc syringe only |
2,187 |
1,640 |
$55K |
| A7046 |
Repl water chamber, pap dev |
4,468 |
3,989 |
$51K |
| E0971 |
Wheelchair anti-tipping devi |
8,335 |
3,595 |
$51K |
| E0471 |
Rad w/backup non inv intrfc |
195 |
158 |
$51K |
| A7526 |
Tracheostomy tube collar |
767 |
623 |
$48K |
| K0003 |
Lightweight wheelchair |
1,074 |
917 |
$48K |
| B4036 |
Enteral feed sup kit grav by |
292 |
269 |
$47K |
| A4606 |
Oxygen probe used w oximeter |
1,145 |
728 |
$47K |
| A4217 |
Sterile water/saline, 500 ml |
1,793 |
1,227 |
$42K |
| A4628 |
Oropharyngeal suction cath |
2,614 |
2,281 |
$39K |
| B4153 |
Ef hydrolyzed/amino acids |
89 |
63 |
$37K |
| A7000 |
Disposable canister for pump |
3,010 |
2,660 |
$37K |
| E0619 |
Apnea monitor w recorder |
105 |
80 |
$36K |
| E0181 |
Press pad alternating w/ pum |
1,978 |
1,712 |
$35K |
| A7507 |
Integrated filter & holder |
257 |
223 |
$34K |
| K0006 |
Heavy duty wheelchair |
610 |
521 |
$33K |
| A7039 |
Filter, non disposable w pap |
4,850 |
4,345 |
$32K |
| K0007 |
Extra heavy duty wheelchair |
333 |
253 |
$30K |
| K0195 |
Elevating whlchair leg rests |
3,444 |
2,880 |
$30K |
| A7033 |
Replacement nasal pillows |
1,414 |
1,208 |
$30K |
| E0776 |
Iv pole |
1,188 |
1,009 |
$29K |
| E0247 |
Trans bench w/wo comm open |
287 |
242 |
$29K |
| A7002 |
Tubing used w suction pump |
3,342 |
2,688 |
$24K |
| E2601 |
Gen w/c cushion wdth < 22 in |
838 |
730 |
$23K |
| E0431 |
Portable gaseous 02 |
1,259 |
1,146 |
$23K |
| E0245 |
Tub stool or bench |
170 |
157 |
$20K |
| E0149 |
Heavy duty wheeled walker |
1,059 |
879 |
$19K |
| A7037 |
Pos airway pressure tubing |
906 |
845 |
$17K |
| K0002 |
Stnd hemi (low seat) whlchr |
255 |
221 |
$15K |
| E0156 |
Walker seat attachment |
1,237 |
1,083 |
$12K |
| A6402 |
Sterile gauze <= 16 sq in |
1,949 |
1,347 |
$11K |
| A4670 |
Automatic bp monitor, dial |
103 |
100 |
$11K |
| E2611 |
Gen use back cush wdth <22in |
89 |
88 |
$11K |
| A4216 |
Sterile water/saline, 10 ml |
348 |
221 |
$10K |
| E0118 |
Crutch substitute |
354 |
241 |
$8K |
| A9901 |
Delivery/set up/dispensing |
1,552 |
1,212 |
$8K |
| T4521 |
Adult size brief/diaper sm |
91 |
86 |
$8K |
| A4616 |
Tubing (oxygen) per foot |
494 |
345 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
1,664 |
1,374 |
$7K |
| A4357 |
Bedside drainage bag |
443 |
397 |
$6K |
| A4335 |
Incontinence supply |
2,238 |
1,535 |
$6K |
| A4618 |
Breathing circuits |
123 |
79 |
$6K |
| A4657 |
Syringe w/wo needle |
612 |
502 |
$5K |
| E1028 |
W/c manual swingaway |
191 |
177 |
$5K |
| B4155 |
Ef incomplete/modular |
71 |
63 |
$4K |
| A6216 |
Non-sterile gauze<=16 sq in |
496 |
347 |
$4K |
| E0240 |
Bath/shower chair |
147 |
54 |
$4K |
| A4239 |
Non-adju cgm supply allow |
26 |
26 |
$4K |
| A7005 |
Nondisposable nebulizer set |
260 |
229 |
$4K |
| E0961 |
Wheelchair brake extension |
1,942 |
805 |
$3K |
| A4450 |
Non-waterproof tape |
938 |
558 |
$3K |
| E0910 |
Trapeze bar attached to bed |
380 |
286 |
$2K |
| A7003 |
Nebulizer administration set |
1,015 |
862 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
266 |
231 |
$2K |
| A6530 |
Compression stocking bk18-30 |
64 |
28 |
$2K |
| A4615 |
Cannula nasal |
737 |
369 |
$1K |
| A4402 |
Lubricant per ounce |
89 |
62 |
$894.73 |
| A7015 |
Aerosol mask used w nebulize |
940 |
822 |
$821.03 |
| E0163 |
Commode chair with fixed arm |
27 |
15 |
$816.84 |
| A4629 |
Tracheostomy care kit |
14 |
12 |
$710.16 |
| A4332 |
Lube sterile packet |
45 |
44 |
$524.96 |
| A7013 |
Disposable compressor filter |
89 |
84 |
$114.03 |
| A4244 |
Alcohol or peroxide per pint |
117 |
64 |
$88.50 |
| A9900 |
Supply/accessory/service |
401 |
275 |
$36.48 |
| E0305 |
Rails bed side half length |
137 |
90 |
$34.18 |
| XZERO |
|
106 |
98 |
$0.00 |