| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
72,141 |
70,130 |
$3.91M |
| B4161 |
Ef ped hydrolyzed/amino acid |
8,242 |
7,467 |
$3.29M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
18,872 |
15,169 |
$2.32M |
| E0603 |
Electric breast pump |
9,816 |
9,766 |
$1.92M |
| B4149 |
Ef blenderized foods |
4,692 |
3,956 |
$1.44M |
| T4527 |
Adult size pull-on lg |
14,554 |
13,970 |
$1.30M |
| E1399 |
Durable medical equipment mi |
1,102 |
895 |
$1.29M |
| E0465 |
Home vent invasive interface |
1,788 |
1,742 |
$1.18M |
| A7030 |
Cpap full face mask |
16,632 |
16,333 |
$1.16M |
| E0202 |
Phototherapy light w/ photom |
2,494 |
2,250 |
$1.05M |
| T4526 |
Adult size pull-on med |
12,397 |
11,882 |
$968K |
| T4528 |
Adult size pull-on xl |
9,132 |
8,713 |
$839K |
| E0601 |
Cont airway pressure device |
23,984 |
23,485 |
$818K |
| A4351 |
Straight tip urine catheter |
7,702 |
6,701 |
$758K |
| T4535 |
Disposable liner/shield/pad |
19,409 |
18,179 |
$744K |
| A4604 |
Tubing with heating element |
23,977 |
23,598 |
$713K |
| B4035 |
Enteral feed supp pump per d |
6,577 |
5,989 |
$709K |
| E0466 |
Home vent non-invasive inter |
985 |
957 |
$567K |
| B4150 |
Ef complet w/intact nutrient |
7,568 |
5,801 |
$554K |
| T4541 |
Large disposable underpad |
24,906 |
23,547 |
$536K |
| T4522 |
Adult size brief/diaper med |
5,997 |
5,727 |
$500K |
| A7031 |
Replacement facemask interfa |
17,562 |
17,266 |
$483K |
| T4534 |
Youth size pull-on |
7,118 |
6,605 |
$480K |
| A4352 |
Coude tip urinary catheter |
1,309 |
1,141 |
$476K |
| T4544 |
Adlt disp und/pull on abv xl |
2,739 |
2,533 |
$465K |
| A7034 |
Nasal application device |
9,981 |
9,794 |
$463K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,038 |
3,167 |
$460K |
| E0439 |
Stationary liquid 02 |
9,430 |
9,039 |
$453K |
| T4523 |
Adult size brief/diaper lg |
4,980 |
4,718 |
$446K |
| E0431 |
Portable gaseous 02 |
36,323 |
35,200 |
$435K |
| A4927 |
Non-sterile gloves |
34,584 |
31,205 |
$423K |
| E0562 |
Humidifier heated used w pap |
7,365 |
7,235 |
$408K |
| E0471 |
Rad w/backup non inv intrfc |
2,016 |
1,926 |
$377K |
| E0570 |
Nebulizer with compression |
38,759 |
37,753 |
$376K |
| T4530 |
Ped size brief/diaper lg |
4,098 |
3,801 |
$292K |
| T4521 |
Adult size brief/diaper sm |
3,802 |
3,618 |
$288K |
| E0470 |
Rad w/o backup non-inv intfc |
3,938 |
3,849 |
$269K |
| T4525 |
Adult size pull-on sm |
3,955 |
3,811 |
$263K |
| K0108 |
W/c component-accessory nos |
1,291 |
941 |
$250K |
| E1392 |
Portable oxygen concentrator |
12,260 |
11,864 |
$247K |
| E0445 |
Oximeter non-invasive |
2,271 |
2,225 |
$244K |
| A7035 |
Pos airway press headgear |
16,963 |
16,663 |
$244K |
| A4217 |
Sterile water/saline, 500 ml |
3,320 |
2,797 |
$237K |
| T4524 |
Adult size brief/diaper xl |
2,273 |
2,172 |
$220K |
| T4537 |
Reusable underpad bed size |
8,478 |
8,218 |
$216K |
| A7032 |
Replacement nasal cushion |
7,380 |
7,189 |
$202K |
| E0424 |
Stationary compressed gas 02 |
3,011 |
2,984 |
$189K |
| A4322 |
Irrigation syringe |
6,366 |
5,911 |
$180K |
| B4088 |
Gastro/jejuno tube, low-pro |
3,563 |
3,355 |
$177K |
| B4154 |
Ef spec metabolic noninherit |
1,289 |
1,030 |
$168K |
| E0600 |
Suction pump portab hom modl |
3,898 |
3,777 |
$156K |
| E0143 |
Walker folding wheeled w/o s |
4,682 |
4,580 |
$152K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,483 |
2,280 |
$145K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,751 |
1,607 |
$145K |
| A7507 |
Integrated filter & holder |
1,664 |
1,280 |
$135K |
| T4543 |
Adult disp brief/diap abv xl |
1,285 |
1,170 |
$134K |
| B4153 |
Ef hydrolyzed/amino acids |
406 |
337 |
$134K |
| A7038 |
Pos airway pressure filter |
34,549 |
33,878 |
$131K |
| B9002 |
Enter nutr inf pump any type |
2,677 |
2,599 |
$131K |
| K0001 |
Standard wheelchair |
8,762 |
8,551 |
$124K |
| E1028 |
W/c manual swingaway |
2,507 |
1,825 |
$118K |
| L1820 |
Ko elas w/ condyle pads & jo |
1,214 |
1,140 |
$109K |
| L4387 |
Non-pneum walk boot pre ots |
879 |
875 |
$108K |
| A4385 |
Ost skn barrier sld ext wear |
2,341 |
2,181 |
$106K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,524 |
3,320 |
$105K |
| A7005 |
Nondisposable nebulizer set |
7,160 |
7,014 |
$103K |
| A7046 |
Repl water chamber, pap dev |
10,923 |
10,689 |
$99K |
| E0434 |
Portable liquid 02 |
9,497 |
9,066 |
$95K |
| A4624 |
Tracheal suction tube |
1,365 |
1,188 |
$94K |
| A4605 |
Trach suction cath close sys |
1,180 |
1,095 |
$84K |
| K0823 |
Pwc gp 2 std cap chair |
456 |
438 |
$84K |
| T4532 |
Ped size pull-on lg |
1,171 |
1,050 |
$84K |
| A4629 |
Tracheostomy care kit |
986 |
903 |
$81K |
| A6530 |
Compression stocking bk18-30 |
2,090 |
1,632 |
$80K |
| A4425 |
Ost pch drain for barrier fl |
1,674 |
1,555 |
$74K |
| A7526 |
Tracheostomy tube collar |
1,785 |
1,625 |
$68K |
| A6212 |
Foam drg <=16 sq in w/border |
655 |
483 |
$68K |
| A5063 |
Drain ostomy pouch w/flange |
1,769 |
1,652 |
$67K |
| L3908 |
Who cock-up nonmolde pre ots |
1,757 |
1,287 |
$65K |
| A7033 |
Replacement nasal pillows |
2,868 |
2,808 |
$61K |
| E0114 |
Crutch underarm pair no wood |
1,503 |
1,492 |
$60K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,915 |
1,411 |
$58K |
| E0442 |
Stationary o2 contents, liq |
3,398 |
3,290 |
$56K |
| A7000 |
Disposable canister for pump |
3,722 |
3,532 |
$54K |
| A7520 |
Trach/laryn tube non-cuffed |
1,198 |
1,045 |
$53K |
| A4623 |
Tracheostomy inner cannula |
486 |
436 |
$50K |
| B4036 |
Enteral feed sup kit grav by |
1,248 |
1,138 |
$50K |
| B4103 |
Ef ped fluid and electrolyte |
807 |
596 |
$50K |
| A4419 |
Ost pch for bar w flange/flt |
1,164 |
1,102 |
$47K |
| B4155 |
Ef incomplete/modular |
772 |
667 |
$45K |
| E0118 |
Crutch substitute |
2,672 |
2,645 |
$44K |
| E0444 |
Portable 02 contents, liquid |
2,610 |
2,546 |
$44K |
| A4349 |
Disposable male external cat |
1,617 |
1,354 |
$43K |
| E0443 |
Portable 02 contents, gas |
2,246 |
2,131 |
$43K |
| A4606 |
Oxygen probe used w oximeter |
3,391 |
1,549 |
$42K |
| E1236 |
Folding ped wc adjustable |
194 |
193 |
$41K |
| E0630 |
Patient lift hydraulic |
1,029 |
997 |
$41K |
| A4357 |
Bedside drainage bag |
5,906 |
5,280 |
$36K |
| B9998 |
Enteral supp not otherwise c |
1,755 |
1,588 |
$35K |
| A4670 |
Automatic bp monitor, dial |
581 |
573 |
$31K |
| K0007 |
Extra heavy duty wheelchair |
486 |
482 |
$31K |
| B4100 |
Food thickener oral |
842 |
768 |
$30K |
| E0955 |
Cushioned headrest |
566 |
539 |
$30K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
509 |
474 |
$30K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
350 |
305 |
$29K |
| E0240 |
Bath/shower chair |
477 |
454 |
$28K |
| A4618 |
Breathing circuits |
1,615 |
1,454 |
$27K |
| A7002 |
Tubing used w suction pump |
3,821 |
3,586 |
$27K |
| A6402 |
Sterile gauze <= 16 sq in |
4,213 |
3,738 |
$26K |
| E0604 |
Hosp grade elec breast pump |
425 |
412 |
$26K |
| A4216 |
Sterile water/saline, 10 ml |
1,565 |
1,414 |
$23K |
| K0195 |
Elevating whlchair leg rests |
2,406 |
2,339 |
$23K |
| A4456 |
Adhesive remover, wipes |
3,376 |
3,165 |
$22K |
| E0973 |
W/ch access det adj armrest |
462 |
311 |
$22K |
| L4386 |
Non-pneum walk boot pre cst |
212 |
209 |
$22K |
| B4034 |
Enter feed supkit syr by day |
895 |
844 |
$21K |
| A4432 |
Os pch urine w bar/fange/tap |
621 |
582 |
$21K |
| B4158 |
Ef ped complete intact nut |
136 |
121 |
$21K |
| A4628 |
Oropharyngeal suction cath |
3,081 |
2,692 |
$21K |
| A7039 |
Filter, non disposable w pap |
4,292 |
4,232 |
$21K |
| A7037 |
Pos airway pressure tubing |
1,778 |
1,726 |
$21K |
| A4483 |
Moisture exchanger |
132 |
125 |
$20K |
| A5120 |
Skin barrier, wipe or swab |
3,415 |
3,049 |
$20K |
| T4529 |
Ped size brief/diaper sm/med |
313 |
297 |
$20K |
| E0776 |
Iv pole |
2,488 |
2,402 |
$18K |
| A4358 |
Urinary leg or abdomen bag |
3,687 |
3,335 |
$17K |
| A4402 |
Lubricant per ounce |
4,286 |
3,834 |
$16K |
| S5161 |
Emer rspns sys serv permonth |
643 |
572 |
$16K |
| K0004 |
High strength ltwt whlchr |
458 |
448 |
$16K |
| A4394 |
Ostomy pouch liq deodorant |
1,299 |
1,220 |
$16K |
| A4452 |
Waterproof tape |
1,996 |
1,775 |
$15K |
| A4362 |
Solid skin barrier |
485 |
457 |
$15K |
| E0971 |
Wheelchair anti-tipping devi |
883 |
690 |
$15K |
| E0149 |
Heavy duty wheeled walker |
578 |
557 |
$15K |
| E0156 |
Walker seat attachment |
1,618 |
1,584 |
$14K |
| A6533 |
Gc stocking thighlngth 18-30 |
249 |
200 |
$13K |
| A4338 |
Indwelling catheter latex |
2,064 |
1,839 |
$13K |
| A7036 |
Pos airway press chinstrap |
1,573 |
1,543 |
$12K |
| A4406 |
Pectin based ostomy paste |
1,217 |
1,158 |
$12K |
| K0003 |
Lightweight wheelchair |
461 |
459 |
$11K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,901 |
1,738 |
$10K |
| E1372 |
Oxy suppl heater for nebuliz |
700 |
669 |
$8K |
| E0181 |
Press pad alternating w/ pum |
777 |
752 |
$8K |
| E0245 |
Tub stool or bench |
127 |
126 |
$8K |
| A4333 |
Urinary cath anchor device |
1,742 |
1,577 |
$8K |
| A4332 |
Lube sterile packet |
898 |
840 |
$7K |
| E1161 |
Manual adult wc w tiltinspac |
12 |
12 |
$7K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
281 |
278 |
$7K |
| A4310 |
Insert tray w/o bag/cath |
1,264 |
1,145 |
$6K |
| A6260 |
Wound cleanser any type/size |
1,118 |
1,011 |
$6K |
| A4331 |
Extension drainage tubing |
1,831 |
1,685 |
$5K |
| A7003 |
Nebulizer administration set |
3,401 |
3,259 |
$5K |
| A7015 |
Aerosol mask used w nebulize |
3,967 |
3,916 |
$5K |
| E2607 |
Skin pro/pos wc cus wd <22in |
25 |
25 |
$5K |
| K0738 |
Portable gas oxygen system |
218 |
208 |
$5K |
| L3809 |
Whfo w/o joints pre ots |
96 |
84 |
$5K |
| L1902 |
Afo ankle gauntlet pre ots |
92 |
89 |
$5K |
| E0565 |
Compressor air power source |
108 |
106 |
$5K |
| E0978 |
W/c acc,saf belt pelv strap |
319 |
317 |
$5K |
| E2622 |
Adj skin pro w/c cus wd<22in |
25 |
25 |
$4K |
| E0163 |
Commode chair with fixed arm |
125 |
123 |
$4K |
| A4371 |
Skin barrier powder per oz |
846 |
811 |
$4K |
| A4344 |
Cath indw foley 2 way silicn |
83 |
62 |
$3K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
198 |
170 |
$3K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
140 |
127 |
$3K |
| E2601 |
Gen w/c cushion wdth < 22 in |
91 |
90 |
$3K |
| K0040 |
Adjustable angle footplate |
49 |
36 |
$2K |
| A4450 |
Non-waterproof tape |
1,516 |
1,409 |
$2K |
| A7014 |
Compressor nondispos filter |
797 |
681 |
$2K |
| S8101 |
Spacer with mask |
53 |
53 |
$2K |
| A4367 |
Ostomy belt |
378 |
369 |
$2K |
| A7521 |
Trach/laryn tube cuffed |
54 |
52 |
$2K |
| E0100 |
Cane adjust/fixed with tip |
138 |
132 |
$2K |
| A4314 |
Cath w/drainage 2-way latex |
355 |
277 |
$2K |
| A6257 |
Transparent film <= 16 sq in |
116 |
100 |
$1K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
50 |
49 |
$1K |
| E0277 |
Powered pres-redu air mattrs |
12 |
12 |
$1K |
| E2219 |
Foam caster tire any size ea |
23 |
13 |
$914.04 |
| E0960 |
W/c shoulder harness/straps |
13 |
13 |
$857.64 |
| A7007 |
Lg vol nebulizer disposable |
146 |
133 |
$794.31 |
| E2213 |
Pneumatic prop tire insert |
26 |
14 |
$727.52 |
| A6446 |
Conform band s w>=3" <5"/yd |
37 |
26 |
$678.94 |
| A7012 |
Nebulizer water collec devic |
143 |
128 |
$628.39 |
| A4213 |
20+ cc syringe only |
71 |
65 |
$559.61 |
| A4245 |
Alcohol wipes per box |
198 |
185 |
$540.14 |
| E0244 |
Toilet seat raised |
19 |
19 |
$521.17 |
| A4334 |
Urinary cath leg strap |
292 |
267 |
$479.15 |
| E0248 |
Hdtrans bench w/wo comm open |
19 |
13 |
$437.91 |
| A4520 |
Incontinence garment anytype |
766 |
481 |
$415.84 |
| A4616 |
Tubing (oxygen) per foot |
91 |
73 |
$315.69 |
| E0910 |
Trapeze bar attached to bed |
39 |
39 |
$287.91 |
| A6453 |
Self-adher band w <3"/yd |
12 |
12 |
$61.59 |
| Q0513 |
Disp fee inhal drugs/30 days |
14 |
13 |
$13.20 |
| A9900 |
Supply/accessory/service |
112 |
100 |
$0.00 |