| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
88 |
86 |
$55K |
| A9276 |
Disposable sensor, cgm sys |
77 |
71 |
$39K |
| A4224 |
Supply insulin inf cath/wk |
84 |
81 |
$31K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
232 |
200 |
$29K |
| K0001 |
Standard wheelchair |
406 |
401 |
$15K |
| B4150 |
Ef complet w/intact nutrient |
78 |
76 |
$11K |
| B4152 |
Ef calorie dense>/=1.5kcal |
72 |
59 |
$10K |
| A9274 |
Ext amb insulin delivery sys |
13 |
12 |
$7K |
| B9998 |
Enteral supp not otherwise c |
165 |
149 |
$7K |
| A4225 |
Sup/ext insulin inf pump syr |
82 |
80 |
$7K |
| B4035 |
Enteral feed supp pump per d |
69 |
66 |
$6K |
| K0003 |
Lightweight wheelchair |
100 |
97 |
$5K |
| K0195 |
Elevating whlchair leg rests |
86 |
86 |
$2K |
| B4034 |
Enter feed supkit syr by day |
167 |
164 |
$1K |
| E0431 |
Portable gaseous 02 |
512 |
508 |
$163.94 |
| E1390 |
Oxygen concentrator |
548 |
544 |
$144.74 |
| A4670 |
Automatic bp monitor, dial |
123 |
123 |
$121.20 |
| T4541 |
Large disposable underpad |
314 |
306 |
$61.00 |
| E0601 |
Cont airway pressure device |
777 |
777 |
$0.00 |
| A7038 |
Pos airway pressure filter |
128 |
127 |
$0.00 |
| A6216 |
Non-sterile gauze<=16 sq in |
77 |
75 |
$0.00 |
| A4425 |
Ost pch drain for barrier fl |
27 |
24 |
$0.00 |
| T4527 |
Adult size pull-on lg |
61 |
61 |
$0.00 |
| A7035 |
Pos airway press headgear |
188 |
188 |
$0.00 |
| T4522 |
Adult size brief/diaper med |
110 |
108 |
$0.00 |
| A4409 |
Ost skn barr convex <=4 sq i |
35 |
31 |
$0.00 |
| A4385 |
Ost skn barrier sld ext wear |
45 |
43 |
$0.00 |
| T4528 |
Adult size pull-on xl |
23 |
20 |
$0.00 |
| A7000 |
Disposable canister for pump |
61 |
49 |
$0.00 |
| A7046 |
Repl water chamber, pap dev |
29 |
29 |
$0.00 |
| A7034 |
Nasal application device |
134 |
134 |
$0.00 |
| A4604 |
Tubing with heating element |
46 |
46 |
$0.00 |
| A4927 |
Non-sterile gloves |
125 |
115 |
$0.00 |
| T4526 |
Adult size pull-on med |
80 |
78 |
$0.00 |
| A4357 |
Bedside drainage bag |
53 |
45 |
$0.00 |
| A6402 |
Sterile gauze <= 16 sq in |
139 |
131 |
$0.00 |
| E0295 |
Hosp bed semi-elect w/o matt |
90 |
90 |
$0.00 |
| A4452 |
Waterproof tape |
14 |
13 |
$0.00 |
| E0163 |
Commode chair with fixed arm |
15 |
15 |
$0.00 |
| T4525 |
Adult size pull-on sm |
32 |
28 |
$0.00 |
| A7003 |
Nebulizer administration set |
16 |
16 |
$0.00 |
| T4524 |
Adult size brief/diaper xl |
25 |
22 |
$0.00 |
| E0603 |
Electric breast pump |
142 |
142 |
$0.00 |
| T4535 |
Disposable liner/shield/pad |
109 |
101 |
$0.00 |
| T4523 |
Adult size brief/diaper lg |
117 |
117 |
$0.00 |
| A4456 |
Adhesive remover, wipes |
77 |
71 |
$0.00 |
| A5120 |
Skin barrier, wipe or swab |
72 |
71 |
$0.00 |
| A7037 |
Pos airway pressure tubing |
130 |
130 |
$0.00 |
| A7030 |
Cpap full face mask |
39 |
39 |
$0.00 |
| A7015 |
Aerosol mask used w nebulize |
58 |
57 |
$0.00 |
| E0470 |
Rad w/o backup non-inv intfc |
65 |
65 |
$0.00 |
| T4534 |
Youth size pull-on |
15 |
15 |
$0.00 |
| E0271 |
Mattress innerspring |
91 |
91 |
$0.00 |
| E0144 |
Enclosed walker w rear seat |
12 |
12 |
$0.00 |
| E1392 |
Portable oxygen concentrator |
44 |
42 |
$0.00 |
| A4351 |
Straight tip urine catheter |
48 |
42 |
$0.00 |
| E0562 |
Humidifier heated used w pap |
882 |
882 |
$0.00 |
| A4217 |
Sterile water/saline, 500 ml |
102 |
94 |
$0.00 |
| E0305 |
Rails bed side half length |
83 |
83 |
$0.00 |
| E0570 |
Nebulizer with compression |
42 |
42 |
$0.00 |
| E0143 |
Walker folding wheeled w/o s |
115 |
115 |
$0.00 |
| A6197 |
Alginate drsg >16 <=48 sq in |
14 |
14 |
$0.00 |
| A7032 |
Replacement nasal cushion |
14 |
14 |
$0.00 |
| A4335 |
Incontinence supply |
12 |
12 |
$0.00 |