| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
200 |
196 |
$22K |
| A4624 |
Tracheal suction tube |
40 |
39 |
$18K |
| A4606 |
Oxygen probe used w oximeter |
119 |
119 |
$13K |
| B4088 |
Gastro/jejuno tube, low-pro |
306 |
205 |
$12K |
| A7526 |
Tracheostomy tube collar |
83 |
83 |
$7K |
| A4554 |
Disposable underpads |
211 |
210 |
$5K |
| A4927 |
Non-sterile gloves |
263 |
261 |
$4K |
| T4530 |
Ped size brief/diaper lg |
141 |
139 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
76 |
75 |
$3K |
| A7000 |
Disposable canister for pump |
150 |
148 |
$3K |
| A4628 |
Oropharyngeal suction cath |
123 |
121 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
90 |
89 |
$1K |
| A7002 |
Tubing used w suction pump |
142 |
141 |
$1K |
| A4657 |
Syringe w/wo needle |
134 |
131 |
$710.60 |
| A7003 |
Nebulizer administration set |
170 |
169 |
$542.72 |
| A7018 |
Water distilled w/nebulizer |
116 |
115 |
$291.20 |
| A4245 |
Alcohol wipes per box |
24 |
24 |
$62.95 |
| A7013 |
Disposable compressor filter |
77 |
76 |
$25.24 |
| A9900 |
Supply/accessory/service |
27 |
25 |
$0.00 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
97 |
87 |
$0.00 |
| E0431 |
Portable gaseous 02 |
30 |
30 |
$0.00 |
| A7014 |
Compressor nondispos filter |
58 |
58 |
$0.00 |
| A4335 |
Incontinence supply |
180 |
178 |
$0.00 |
| E1390 |
Oxygen concentrator |
57 |
54 |
$0.00 |