| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
26,201 |
26,024 |
$1.08M |
| T4523 |
Adult size brief/diaper lg |
13,024 |
12,961 |
$1.07M |
| T4522 |
Adult size brief/diaper med |
14,324 |
14,241 |
$990K |
| B4153 |
Ef hydrolyzed/amino acids |
2,549 |
2,512 |
$822K |
| E1390 |
Oxygen concentrator |
10,447 |
10,397 |
$792K |
| T4524 |
Adult size brief/diaper xl |
8,313 |
8,284 |
$726K |
| B4035 |
Enteral feed supp pump per d |
5,731 |
5,518 |
$482K |
| T4521 |
Adult size brief/diaper sm |
6,308 |
6,274 |
$473K |
| T4537 |
Reusable underpad bed size |
15,392 |
15,297 |
$437K |
| T4535 |
Disposable liner/shield/pad |
14,418 |
14,348 |
$358K |
| E1392 |
Portable oxygen concentrator |
5,154 |
5,147 |
$349K |
| T4543 |
Adult disp brief/diap abv xl |
2,020 |
2,017 |
$279K |
| T4533 |
Youth size brief/diaper |
3,090 |
3,072 |
$227K |
| E0601 |
Cont airway pressure device |
4,870 |
4,863 |
$218K |
| A7030 |
Cpap full face mask |
2,219 |
2,218 |
$210K |
| E0470 |
Rad w/o backup non-inv intfc |
1,365 |
1,364 |
$183K |
| E0570 |
Nebulizer with compression |
5,293 |
5,284 |
$173K |
| B4150 |
Ef complet w/intact nutrient |
1,956 |
1,936 |
$142K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,685 |
1,663 |
$122K |
| A4351 |
Straight tip urine catheter |
1,149 |
1,146 |
$105K |
| E0431 |
Portable gaseous 02 |
4,706 |
4,699 |
$92K |
| A4927 |
Non-sterile gloves |
22,800 |
22,641 |
$84K |
| E0562 |
Humidifier heated used w pap |
4,233 |
4,230 |
$69K |
| B9002 |
Enter nutr inf pump any type |
1,399 |
1,355 |
$58K |
| B4154 |
Ef spec metabolic noninherit |
389 |
389 |
$54K |
| K0001 |
Standard wheelchair |
2,138 |
2,133 |
$47K |
| E0143 |
Walker folding wheeled w/o s |
872 |
872 |
$43K |
| E0445 |
Oximeter non-invasive |
242 |
241 |
$36K |
| A7037 |
Pos airway pressure tubing |
2,880 |
2,876 |
$25K |
| A7035 |
Pos airway press headgear |
1,840 |
1,836 |
$23K |
| E0261 |
Hosp bed semi-electr w/o mat |
426 |
412 |
$22K |
| T4540 |
Reusable underpad chair size |
1,286 |
1,271 |
$22K |
| E0240 |
Bath/shower chair |
615 |
606 |
$19K |
| A6402 |
Sterile gauze <= 16 sq in |
1,542 |
1,532 |
$17K |
| A7034 |
Nasal application device |
416 |
414 |
$13K |
| A4322 |
Irrigation syringe |
1,089 |
1,065 |
$11K |
| B4088 |
Gastro/jejuno tube, low-pro |
96 |
96 |
$11K |
| A6530 |
Compression stocking bk18-30 |
309 |
177 |
$10K |
| B4087 |
Gastro/jejuno tube, std |
894 |
890 |
$10K |
| A4670 |
Automatic bp monitor, dial |
194 |
192 |
$8K |
| A4409 |
Ost skn barr convex <=4 sq i |
230 |
228 |
$8K |
| E0260 |
Hosp bed semi-electr w/ matt |
710 |
708 |
$8K |
| A7003 |
Nebulizer administration set |
3,130 |
3,106 |
$7K |
| A4357 |
Bedside drainage bag |
417 |
408 |
$5K |
| A7000 |
Disposable canister for pump |
722 |
712 |
$5K |
| B9999 |
Parenteral supp not othrws c |
190 |
190 |
$4K |
| A7038 |
Pos airway pressure filter |
2,162 |
2,130 |
$4K |
| L1820 |
Ko elas w/ condyle pads & jo |
49 |
40 |
$4K |
| A4425 |
Ost pch drain for barrier fl |
70 |
67 |
$4K |
| E0776 |
Iv pole |
2,033 |
2,029 |
$3K |
| A4450 |
Non-waterproof tape |
578 |
574 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
200 |
199 |
$2K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
12 |
12 |
$2K |
| B4034 |
Enter feed supkit syr by day |
53 |
53 |
$2K |
| E0156 |
Walker seat attachment |
144 |
144 |
$2K |
| E1399 |
Durable medical equipment mi |
12 |
12 |
$2K |
| E0181 |
Press pad alternating w/ pum |
199 |
198 |
$1K |
| A4628 |
Oropharyngeal suction cath |
394 |
384 |
$1K |
| A4310 |
Insert tray w/o bag/cath |
381 |
381 |
$1K |
| A7002 |
Tubing used w suction pump |
938 |
705 |
$1K |
| L3908 |
Who cock-up nonmolde pre ots |
17 |
16 |
$865.74 |
| B4100 |
Food thickener oral |
24 |
24 |
$709.32 |
| A5063 |
Drain ostomy pouch w/flange |
14 |
14 |
$570.07 |
| A5120 |
Skin barrier, wipe or swab |
37 |
37 |
$297.81 |
| E0149 |
Heavy duty wheeled walker |
12 |
12 |
$230.47 |
| E0100 |
Cane adjust/fixed with tip |
12 |
12 |
$126.21 |