| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
1,169 |
887 |
$452K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,428 |
1,173 |
$322K |
| E1390 |
Oxygen concentrator |
7,046 |
5,845 |
$302K |
| B4035 |
Enteral feed supp pump per d |
2,056 |
1,544 |
$182K |
| B4149 |
Ef blenderized foods |
506 |
393 |
$103K |
| B4152 |
Ef calorie dense>/=1.5kcal |
873 |
627 |
$62K |
| E0465 |
Home vent invasive interface |
163 |
91 |
$60K |
| B4150 |
Ef complet w/intact nutrient |
688 |
521 |
$57K |
| K0738 |
Portable gas oxygen system |
2,461 |
2,143 |
$50K |
| E0601 |
Cont airway pressure device |
1,019 |
910 |
$43K |
| A4629 |
Tracheostomy care kit |
566 |
379 |
$34K |
| E1392 |
Portable oxygen concentrator |
1,638 |
1,416 |
$31K |
| B9002 |
Enter nutr inf pump any type |
927 |
748 |
$31K |
| K0003 |
Lightweight wheelchair |
1,085 |
828 |
$29K |
| B4034 |
Enter feed supkit syr by day |
426 |
357 |
$28K |
| S9342 |
Hit enteral pump diem |
178 |
137 |
$25K |
| A7030 |
Cpap full face mask |
596 |
460 |
$25K |
| E0570 |
Nebulizer with compression |
785 |
670 |
$22K |
| E0143 |
Walker folding wheeled w/o s |
835 |
737 |
$21K |
| A7526 |
Tracheostomy tube collar |
694 |
430 |
$20K |
| E0260 |
Hosp bed semi-electr w/ matt |
508 |
436 |
$19K |
| E0445 |
Oximeter non-invasive |
153 |
138 |
$18K |
| A4604 |
Tubing with heating element |
822 |
649 |
$17K |
| E0431 |
Portable gaseous 02 |
1,330 |
1,140 |
$16K |
| E0562 |
Humidifier heated used w pap |
682 |
605 |
$14K |
| K0001 |
Standard wheelchair |
653 |
536 |
$11K |
| K0195 |
Elevating whlchair leg rests |
1,530 |
1,205 |
$11K |
| E0619 |
Apnea monitor w recorder |
77 |
72 |
$11K |
| E0163 |
Commode chair with fixed arm |
411 |
360 |
$10K |
| B4088 |
Gastro/jejuno tube, low-pro |
463 |
417 |
$10K |
| B4153 |
Ef hydrolyzed/amino acids |
40 |
25 |
$10K |
| A7000 |
Disposable canister for pump |
954 |
641 |
$9K |
| E0600 |
Suction pump portab hom modl |
379 |
309 |
$8K |
| A7031 |
Replacement facemask interfa |
498 |
360 |
$7K |
| A7035 |
Pos airway press headgear |
663 |
541 |
$6K |
| E0470 |
Rad w/o backup non-inv intfc |
114 |
91 |
$5K |
| A7520 |
Trach/laryn tube non-cuffed |
160 |
118 |
$5K |
| A4624 |
Tracheal suction tube |
71 |
50 |
$5K |
| B4155 |
Ef incomplete/modular |
56 |
50 |
$5K |
| A4628 |
Oropharyngeal suction cath |
774 |
501 |
$4K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
202 |
181 |
$4K |
| A7002 |
Tubing used w suction pump |
923 |
617 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
102 |
79 |
$3K |
| A7034 |
Nasal application device |
58 |
49 |
$2K |
| A7003 |
Nebulizer administration set |
1,058 |
805 |
$1K |
| A7038 |
Pos airway pressure filter |
992 |
781 |
$1K |
| A4623 |
Tracheostomy inner cannula |
18 |
13 |
$1K |
| A7521 |
Trach/laryn tube cuffed |
48 |
24 |
$900.61 |
| E0149 |
Heavy duty wheeled walker |
12 |
12 |
$466.48 |
| A7046 |
Repl water chamber, pap dev |
120 |
87 |
$464.32 |
| A4606 |
Oxygen probe used w oximeter |
65 |
37 |
$409.44 |
| E0245 |
Tub stool or bench |
15 |
12 |
$344.40 |
| E2601 |
Gen w/c cushion wdth < 22 in |
16 |
12 |
$281.79 |
| A7015 |
Aerosol mask used w nebulize |
287 |
246 |
$226.10 |
| A7013 |
Disposable compressor filter |
222 |
204 |
$78.61 |