| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
90 |
89 |
$12K |
| A4624 |
Tracheal suction tube |
13 |
13 |
$7K |
| B4088 |
Gastro/jejuno tube, low-pro |
163 |
99 |
$7K |
| A4606 |
Oxygen probe used w oximeter |
41 |
41 |
$6K |
| T4530 |
Ped size brief/diaper lg |
55 |
55 |
$2K |
| A4554 |
Disposable underpads |
66 |
66 |
$2K |
| A4927 |
Non-sterile gloves |
106 |
104 |
$2K |
| A7526 |
Tracheostomy tube collar |
15 |
15 |
$2K |
| A7000 |
Disposable canister for pump |
52 |
52 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
33 |
33 |
$936.96 |
| A4628 |
Oropharyngeal suction cath |
41 |
41 |
$890.10 |
| A7002 |
Tubing used w suction pump |
53 |
53 |
$508.32 |
| A6402 |
Sterile gauze <= 16 sq in |
34 |
34 |
$489.00 |
| A4657 |
Syringe w/wo needle |
78 |
77 |
$446.38 |
| A4213 |
20+ cc syringe only |
28 |
28 |
$306.24 |
| A7003 |
Nebulizer administration set |
58 |
58 |
$206.01 |
| A7018 |
Water distilled w/nebulizer |
39 |
39 |
$139.23 |
| A4245 |
Alcohol wipes per box |
26 |
26 |
$60.50 |
| A7013 |
Disposable compressor filter |
32 |
32 |
$20.78 |
| A7014 |
Compressor nondispos filter |
16 |
16 |
$0.00 |
| B4161 |
Ef ped hydrolyzed/amino acid |
12 |
12 |
$0.00 |
| E0431 |
Portable gaseous 02 |
13 |
13 |
$0.00 |
| A4483 |
Moisture exchanger |
12 |
12 |
$0.00 |
| A4335 |
Incontinence supply |
80 |
80 |
$0.00 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
44 |
40 |
$0.00 |
| E1390 |
Oxygen concentrator |
16 |
15 |
$0.00 |