| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
14,673 |
13,165 |
$11.92M |
| B4035 |
Enteral feed supp pump per d |
20,135 |
19,340 |
$6.59M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
18,261 |
15,150 |
$4.41M |
| B9998 |
Enteral supp not otherwise c |
44,520 |
22,353 |
$2.81M |
| E0465 |
Home vent invasive interface |
2,704 |
2,597 |
$2.64M |
| E1390 |
Oxygen concentrator |
18,977 |
18,426 |
$2.64M |
| B4149 |
Ef blenderized foods |
6,216 |
4,219 |
$2.09M |
| B4153 |
Ef hydrolyzed/amino acids |
948 |
866 |
$1.47M |
| T4532 |
Ped size pull-on lg |
8,253 |
7,929 |
$1.37M |
| E1399 |
Durable medical equipment mi |
3,057 |
2,714 |
$1.34M |
| E0570 |
Nebulizer with compression |
10,184 |
10,016 |
$1.21M |
| E0445 |
Oximeter non-invasive |
10,092 |
9,772 |
$1.19M |
| K0553 |
Ther cgm supply allowance |
2,678 |
2,347 |
$1.18M |
| A4239 |
Non-adju cgm supply allow |
5,467 |
5,284 |
$1.17M |
| B4155 |
Ef incomplete/modular |
3,500 |
3,116 |
$1.09M |
| A9900 |
Supply/accessory/service |
16,371 |
9,471 |
$1.01M |
| B9002 |
Enter nutr inf pump any type |
9,338 |
9,031 |
$946K |
| T4530 |
Ped size brief/diaper lg |
7,097 |
6,793 |
$751K |
| L1960 |
Afo pos solid ank plastic mo |
1,433 |
996 |
$640K |
| B4150 |
Ef complet w/intact nutrient |
1,903 |
1,683 |
$608K |
| L1907 |
Afo supramalleolar custom |
1,046 |
723 |
$591K |
| A4605 |
Trach suction cath close sys |
1,626 |
1,530 |
$577K |
| B4158 |
Ef ped complete intact nut |
2,390 |
2,225 |
$545K |
| E0482 |
Cough stimulating device |
2,183 |
2,139 |
$540K |
| A6212 |
Foam drg <=16 sq in w/border |
2,045 |
1,787 |
$504K |
| T4522 |
Adult size brief/diaper med |
4,261 |
4,097 |
$485K |
| E0431 |
Portable gaseous 02 |
19,189 |
18,802 |
$471K |
| A4554 |
Disposable underpads |
13,663 |
13,128 |
$466K |
| A4627 |
Spacer bag/reservoir |
14,949 |
14,624 |
$458K |
| B4154 |
Ef spec metabolic noninherit |
691 |
628 |
$432K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
4,091 |
3,084 |
$418K |
| B4103 |
Ef ped fluid and electrolyte |
2,057 |
1,718 |
$411K |
| K0001 |
Standard wheelchair |
10,981 |
10,731 |
$408K |
| T4531 |
Ped size pull-on sm/med |
2,948 |
2,851 |
$380K |
| T1999 |
Noc retail items andsupplies |
46,905 |
20,956 |
$370K |
| E0240 |
Bath/shower chair |
342 |
327 |
$320K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,009 |
878 |
$315K |
| T4521 |
Adult size brief/diaper sm |
2,804 |
2,687 |
$307K |
| A7520 |
Trach/laryn tube non-cuffed |
3,387 |
2,911 |
$306K |
| L2275 |
Plastic mod low ext pad/line |
2,776 |
1,922 |
$297K |
| A4624 |
Tracheal suction tube |
2,126 |
1,980 |
$295K |
| T4525 |
Adult size pull-on sm |
2,674 |
2,601 |
$293K |
| E0601 |
Cont airway pressure device |
6,358 |
6,236 |
$286K |
| L2840 |
Tibial length sock fx or equ |
2,132 |
1,507 |
$286K |
| A6260 |
Wound cleanser any type/size |
4,606 |
4,273 |
$282K |
| A7000 |
Disposable canister for pump |
7,307 |
7,083 |
$277K |
| A4322 |
Irrigation syringe |
15,307 |
14,472 |
$264K |
| A4606 |
Oxygen probe used w oximeter |
2,351 |
2,246 |
$254K |
| A4351 |
Straight tip urine catheter |
1,471 |
1,286 |
$248K |
| A4483 |
Moisture exchanger |
1,590 |
1,478 |
$225K |
| A7526 |
Tracheostomy tube collar |
4,170 |
3,890 |
$224K |
| T4527 |
Adult size pull-on lg |
1,443 |
1,371 |
$215K |
| T4526 |
Adult size pull-on med |
1,755 |
1,689 |
$209K |
| B4100 |
Food thickener oral |
4,034 |
3,873 |
$208K |
| A4629 |
Tracheostomy care kit |
1,763 |
1,701 |
$198K |
| A4222 |
Infusion supplies with pump |
1,151 |
498 |
$188K |
| A9279 |
Monitoring feature/devicenoc |
1,381 |
1,303 |
$186K |
| A4335 |
Incontinence supply |
28,935 |
27,986 |
$186K |
| T4534 |
Youth size pull-on |
1,448 |
1,388 |
$183K |
| E0466 |
Home vent non-invasive inter |
210 |
208 |
$183K |
| L3908 |
Who cock-up nonmolde pre ots |
4,680 |
4,592 |
$156K |
| B4104 |
Additive for enteral formula |
903 |
864 |
$153K |
| A7002 |
Tubing used w suction pump |
6,889 |
6,682 |
$152K |
| E0619 |
Apnea monitor w recorder |
1,098 |
1,048 |
$149K |
| L2820 |
Soft interface below knee se |
2,119 |
1,510 |
$140K |
| K0108 |
W/c component-accessory nos |
935 |
303 |
$138K |
| E0791 |
Parenteral infusion pump sta |
846 |
670 |
$131K |
| T4523 |
Adult size brief/diaper lg |
1,088 |
1,051 |
$130K |
| A6402 |
Sterile gauze <= 16 sq in |
14,198 |
12,286 |
$129K |
| L3010 |
Foot longitudinal arch suppo |
1,017 |
692 |
$118K |
| L2280 |
Molded inner boot |
345 |
246 |
$117K |
| K0554 |
Ther cgm receiver/monitor |
228 |
212 |
$104K |
| A6196 |
Alginate dressing <=16 sq in |
554 |
510 |
$96K |
| E0990 |
Wheelchair elevating leg res |
10,094 |
6,073 |
$92K |
| E0202 |
Phototherapy light w/ photom |
1,151 |
425 |
$91K |
| A7003 |
Nebulizer administration set |
19,670 |
19,171 |
$79K |
| A4670 |
Automatic bp monitor, dial |
1,368 |
1,353 |
$78K |
| A4628 |
Oropharyngeal suction cath |
7,552 |
6,441 |
$77K |
| E0776 |
Iv pole |
9,245 |
8,942 |
$75K |
| L1902 |
Afo ankle gauntlet pre ots |
1,290 |
1,268 |
$74K |
| E0471 |
Rad w/backup non inv intrfc |
326 |
303 |
$70K |
| E0114 |
Crutch underarm pair no wood |
2,586 |
2,520 |
$69K |
| A4362 |
Solid skin barrier |
766 |
514 |
$69K |
| A7521 |
Trach/laryn tube cuffed |
544 |
461 |
$66K |
| A4212 |
Non coring needle or stylet |
1,532 |
873 |
$65K |
| L1200 |
Furnsh initial orthosis only |
59 |
55 |
$62K |
| L3260 |
Ambulatory surgical boot eac |
2,015 |
1,946 |
$60K |
| S1040 |
Cranial remolding orthosis |
37 |
37 |
$60K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
172 |
167 |
$56K |
| E0143 |
Walker folding wheeled w/o s |
713 |
698 |
$53K |
| A6245 |
Hydrogel drg <= 16 in w/bdr |
767 |
726 |
$49K |
| L1830 |
Ko immob canvas long pre ots |
992 |
936 |
$49K |
| E0470 |
Rad w/o backup non-inv intfc |
477 |
472 |
$48K |
| A4927 |
Non-sterile gloves |
2,483 |
2,099 |
$43K |
| A6214 |
Foam drg > 48 sq in w/border |
251 |
238 |
$40K |
| A6259 |
Transparent film > 48 sq in |
319 |
253 |
$39K |
| A4452 |
Waterproof tape |
3,585 |
3,169 |
$39K |
| L3809 |
Whfo w/o joints pre ots |
628 |
616 |
$35K |
| E1226 |
Manual fully reclining back |
913 |
885 |
$34K |
| E1028 |
W/c manual swingaway |
129 |
83 |
$33K |
| A4369 |
Skin barrier liquid per oz |
2,197 |
1,752 |
$32K |
| T4535 |
Disposable liner/shield/pad |
1,184 |
1,128 |
$30K |
| A6240 |
Hydrocolld drg filler paste |
390 |
351 |
$28K |
| A6257 |
Transparent film <= 16 sq in |
3,253 |
2,084 |
$28K |
| A6258 |
Transparent film >16<=48 in |
1,340 |
902 |
$27K |
| E0565 |
Compressor air power source |
855 |
834 |
$26K |
| E2103 |
Non-adju cgm receiver/mon |
108 |
105 |
$26K |
| E1060 |
Wheelchair detachable arms |
322 |
312 |
$26K |
| E2617 |
Custom fab w/c back cushion |
25 |
24 |
$26K |
| T4533 |
Youth size brief/diaper |
221 |
211 |
$24K |
| E0562 |
Humidifier heated used w pap |
2,199 |
2,145 |
$22K |
| A7015 |
Aerosol mask used w nebulize |
15,094 |
14,664 |
$22K |
| L4386 |
Non-pneum walk boot pre cst |
166 |
160 |
$21K |
| E8001 |
Upright gait trainer |
13 |
13 |
$21K |
| A4398 |
Ostomy irrigation bag |
266 |
223 |
$20K |
| E0955 |
Cushioned headrest |
109 |
109 |
$20K |
| A7037 |
Pos airway pressure tubing |
811 |
777 |
$16K |
| L1832 |
Ko adj jnt pos r sup pre cst |
59 |
57 |
$15K |
| A6250 |
Skin seal protect moisturizr |
1,711 |
1,544 |
$14K |
| A4402 |
Lubricant per ounce |
2,536 |
2,456 |
$13K |
| L4387 |
Non-pneum walk boot pre ots |
332 |
322 |
$13K |
| E0960 |
W/c shoulder harness/straps |
130 |
124 |
$12K |
| K0040 |
Adjustable angle footplate |
93 |
91 |
$11K |
| K0195 |
Elevating whlchair leg rests |
866 |
841 |
$11K |
| L1210 |
Lateral thoracic extension |
60 |
56 |
$11K |
| A4215 |
Sterile needle |
3,354 |
1,638 |
$10K |
| E0600 |
Suction pump portab hom modl |
31 |
25 |
$10K |
| A7030 |
Cpap full face mask |
86 |
85 |
$10K |
| E0247 |
Trans bench w/wo comm open |
109 |
105 |
$10K |
| L1810 |
Ko elastic with joints |
154 |
147 |
$10K |
| A7034 |
Nasal application device |
130 |
124 |
$9K |
| A4467 |
Belt strap sleev grmnt cover |
161 |
155 |
$8K |
| A7013 |
Disposable compressor filter |
13,931 |
13,555 |
$8K |
| E0973 |
W/ch access det adj armrest |
56 |
56 |
$8K |
| A4456 |
Adhesive remover, wipes |
1,595 |
1,215 |
$8K |
| L4350 |
Ankle control ortho pre ots |
192 |
186 |
$7K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
116 |
111 |
$7K |
| E0971 |
Wheelchair anti-tipping devi |
92 |
92 |
$7K |
| A4371 |
Skin barrier powder per oz |
823 |
792 |
$6K |
| L1820 |
Ko elas w/ condyle pads & jo |
71 |
69 |
$6K |
| A7525 |
Tracheostomy mask |
1,489 |
1,447 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
159 |
155 |
$6K |
| T4529 |
Ped size brief/diaper sm/med |
92 |
86 |
$5K |
| A4250 |
Urine reagent strips/tablets |
476 |
464 |
$5K |
| A4245 |
Alcohol wipes per box |
2,710 |
2,232 |
$5K |
| A4565 |
Slings |
494 |
485 |
$3K |
| A4248 |
Chlorhexidine antisept |
1,597 |
869 |
$3K |
| A7038 |
Pos airway pressure filter |
841 |
812 |
$3K |
| K0038 |
Leg strap each |
70 |
67 |
$3K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
14 |
12 |
$3K |
| L3332 |
Shoe lifts tapered to one-ha |
68 |
56 |
$3K |
| A4455 |
Adhesive remover per ounce |
802 |
733 |
$3K |
| A7039 |
Filter, non disposable w pap |
343 |
331 |
$3K |
| B4082 |
Enteral ng tubing w/o stylet |
72 |
69 |
$2K |
| L1240 |
Lumbar derotation pad |
44 |
42 |
$2K |
| A4332 |
Lube sterile packet |
922 |
901 |
$2K |
| A6216 |
Non-sterile gauze<=16 sq in |
153 |
148 |
$1K |
| A7012 |
Nebulizer water collec devic |
177 |
170 |
$1K |
| L8501 |
Tracheostomy speaking valve |
14 |
14 |
$970.43 |
| E0480 |
Percussor elect/pneum home m |
25 |
25 |
$860.33 |
| A4421 |
Ostomy supply misc |
12 |
12 |
$759.00 |
| L1060 |
Thoracic pad |
12 |
12 |
$735.30 |
| A7007 |
Lg vol nebulizer disposable |
108 |
97 |
$601.17 |
| L1290 |
Lateral trochanteric pad |
13 |
12 |
$564.77 |
| A4405 |
Nonpectin based ostomy paste |
64 |
60 |
$559.15 |
| A4930 |
Sterile, gloves per pair |
210 |
132 |
$529.94 |
| A7005 |
Nondisposable nebulizer set |
18 |
15 |
$305.82 |
| A4213 |
20+ cc syringe only |
71 |
67 |
$228.57 |
| A4615 |
Cannula nasal |
152 |
141 |
$171.72 |
| A4450 |
Non-waterproof tape |
64 |
64 |
$103.30 |
| A5120 |
Skin barrier, wipe or swab |
13 |
12 |
$81.35 |
| A4649 |
Surgical supplies |
13 |
13 |
$47.84 |
| A4616 |
Tubing (oxygen) per foot |
46 |
29 |
$2.15 |