| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
3,248 |
3,228 |
$471K |
| B4035 |
Enteral feed supp pump per d |
2,741 |
2,700 |
$368K |
| B9998 |
Enteral supp not otherwise c |
2,200 |
1,297 |
$346K |
| T4530 |
Ped size brief/diaper lg |
2,337 |
2,324 |
$326K |
| T4523 |
Adult size brief/diaper lg |
2,561 |
2,556 |
$300K |
| T4541 |
Large disposable underpad |
7,079 |
7,046 |
$267K |
| B4150 |
Ef complet w/intact nutrient |
1,829 |
1,810 |
$258K |
| T4522 |
Adult size brief/diaper med |
2,348 |
2,325 |
$224K |
| E1390 |
Oxygen concentrator |
2,462 |
2,457 |
$202K |
| T4535 |
Disposable liner/shield/pad |
3,245 |
3,223 |
$168K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
851 |
844 |
$161K |
| T4524 |
Adult size brief/diaper xl |
987 |
984 |
$140K |
| T4526 |
Adult size pull-on med |
1,324 |
1,315 |
$136K |
| A4927 |
Non-sterile gloves |
5,116 |
5,088 |
$118K |
| T4527 |
Adult size pull-on lg |
940 |
930 |
$90K |
| A7030 |
Cpap full face mask |
1,050 |
1,047 |
$79K |
| E0601 |
Cont airway pressure device |
2,211 |
2,195 |
$72K |
| T4537 |
Reusable underpad bed size |
3,554 |
3,551 |
$58K |
| T4532 |
Ped size pull-on lg |
386 |
384 |
$52K |
| E0570 |
Nebulizer with compression |
717 |
714 |
$38K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,457 |
1,452 |
$24K |
| B4149 |
Ef blenderized foods |
68 |
67 |
$23K |
| A7034 |
Nasal application device |
700 |
698 |
$22K |
| A7031 |
Replacement facemask interfa |
891 |
885 |
$21K |
| A7037 |
Pos airway pressure tubing |
1,723 |
1,722 |
$18K |
| A7526 |
Tracheostomy tube collar |
558 |
401 |
$18K |
| A7035 |
Pos airway press headgear |
1,119 |
1,119 |
$15K |
| B9002 |
Enter nutr inf pump any type |
159 |
159 |
$13K |
| T4525 |
Adult size pull-on sm |
113 |
113 |
$11K |
| B4087 |
Gastro/jejuno tube, std |
373 |
373 |
$9K |
| A7000 |
Disposable canister for pump |
1,355 |
1,228 |
$7K |
| A4335 |
Incontinence supply |
209 |
200 |
$7K |
| E0630 |
Patient lift hydraulic |
383 |
383 |
$6K |
| A7038 |
Pos airway pressure filter |
2,137 |
2,134 |
$6K |
| A7046 |
Repl water chamber, pap dev |
665 |
664 |
$5K |
| A7002 |
Tubing used w suction pump |
1,836 |
1,672 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
163 |
163 |
$4K |
| T4521 |
Adult size brief/diaper sm |
36 |
36 |
$3K |
| A7003 |
Nebulizer administration set |
1,060 |
1,058 |
$3K |
| A4628 |
Oropharyngeal suction cath |
139 |
138 |
$2K |
| E0562 |
Humidifier heated used w pap |
96 |
96 |
$2K |
| E0181 |
Press pad alternating w/ pum |
215 |
215 |
$1K |
| A7525 |
Tracheostomy mask |
634 |
549 |
$1K |
| A4213 |
20+ cc syringe only |
78 |
66 |
$996.24 |
| A9901 |
Delivery/set up/dispensing |
377 |
367 |
$889.35 |
| B4100 |
Food thickener oral |
13 |
13 |
$826.64 |
| K0738 |
Portable gas oxygen system |
89 |
89 |
$751.39 |
| A4216 |
Sterile water/saline, 10 ml |
17 |
17 |
$385.22 |
| A7012 |
Nebulizer water collec devic |
61 |
61 |
$358.92 |
| A6216 |
Non-sterile gauze<=16 sq in |
28 |
28 |
$262.00 |
| A6402 |
Sterile gauze <= 16 sq in |
30 |
30 |
$245.52 |
| A4452 |
Waterproof tape |
16 |
15 |
$139.40 |
| A7015 |
Aerosol mask used w nebulize |
52 |
52 |
$68.40 |