| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B9998 |
Enteral supp not otherwise c |
25,858 |
14,000 |
$7.71M |
| E1399 |
Durable medical equipment mi |
1,573 |
924 |
$6.42M |
| B4035 |
Enteral feed supp pump per d |
14,678 |
12,978 |
$4.46M |
| B4161 |
Ef ped hydrolyzed/amino acid |
6,921 |
6,003 |
$4.37M |
| A9999 |
Dme supply or accessory, nos |
12,698 |
6,478 |
$4.02M |
| B4149 |
Ef blenderized foods |
6,964 |
5,734 |
$3.02M |
| B9002 |
Enter nutr inf pump any type |
14,390 |
12,031 |
$1.39M |
| B4034 |
Enter feed supkit syr by day |
8,566 |
7,364 |
$1.31M |
| B4153 |
Ef hydrolyzed/amino acids |
1,356 |
1,202 |
$948K |
| S8189 |
Trach supply noc |
1,383 |
721 |
$836K |
| T4534 |
Youth size pull-on |
7,182 |
7,033 |
$798K |
| A4554 |
Disposable underpads |
20,301 |
19,447 |
$738K |
| T4530 |
Ped size brief/diaper lg |
6,156 |
5,998 |
$717K |
| T5999 |
Supply, nos |
39,772 |
36,366 |
$671K |
| A4628 |
Oropharyngeal suction cath |
4,671 |
3,906 |
$641K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,061 |
2,661 |
$490K |
| T4533 |
Youth size brief/diaper |
3,838 |
3,739 |
$482K |
| T4522 |
Adult size brief/diaper med |
4,284 |
3,769 |
$459K |
| B4036 |
Enteral feed sup kit grav by |
2,384 |
2,091 |
$432K |
| B4088 |
Gastro/jejuno tube, low-pro |
13,199 |
3,528 |
$343K |
| T4521 |
Adult size brief/diaper sm |
2,682 |
2,435 |
$314K |
| A7000 |
Disposable canister for pump |
4,437 |
3,794 |
$304K |
| A4209 |
5+ cc sterile syringe&needle |
12,449 |
11,108 |
$303K |
| T4535 |
Disposable liner/shield/pad |
7,648 |
7,065 |
$281K |
| T4523 |
Adult size brief/diaper lg |
1,405 |
1,170 |
$197K |
| T4532 |
Ped size pull-on lg |
2,196 |
2,155 |
$194K |
| A4353 |
Intermittent urinary cath |
187 |
178 |
$178K |
| A4624 |
Tracheal suction tube |
1,236 |
945 |
$173K |
| B4103 |
Ef ped fluid and electrolyte |
719 |
652 |
$168K |
| A4452 |
Waterproof tape |
6,228 |
5,472 |
$150K |
| E0641 |
Multi-position stnd fram sys |
25 |
12 |
$144K |
| E1028 |
W/c manual swingaway |
624 |
308 |
$140K |
| B4150 |
Ef complet w/intact nutrient |
554 |
492 |
$129K |
| B4154 |
Ef spec metabolic noninherit |
327 |
307 |
$128K |
| T4527 |
Adult size pull-on lg |
1,953 |
1,705 |
$124K |
| A4927 |
Non-sterile gloves |
11,379 |
8,911 |
$120K |
| T4525 |
Adult size pull-on sm |
1,354 |
1,281 |
$107K |
| T4526 |
Adult size pull-on med |
1,604 |
1,543 |
$104K |
| B4155 |
Ef incomplete/modular |
2,432 |
2,115 |
$97K |
| E2609 |
Custom fabricate w/c cushion |
46 |
28 |
$85K |
| A4322 |
Irrigation syringe |
5,809 |
5,081 |
$85K |
| A4213 |
20+ cc syringe only |
5,209 |
4,589 |
$83K |
| T4528 |
Adult size pull-on xl |
1,043 |
959 |
$80K |
| X1915 |
|
389 |
353 |
$78K |
| A4606 |
Oxygen probe used w oximeter |
1,515 |
830 |
$69K |
| B4104 |
Additive for enteral formula |
488 |
413 |
$63K |
| T4529 |
Ped size brief/diaper sm/med |
589 |
578 |
$60K |
| E0700 |
Safety equipment |
258 |
225 |
$46K |
| T5001 |
Position seat spec orth need |
42 |
38 |
$37K |
| A4351 |
Straight tip urine catheter |
235 |
156 |
$36K |
| A7002 |
Tubing used w suction pump |
5,492 |
4,620 |
$31K |
| E2617 |
Custom fab w/c back cushion |
15 |
13 |
$29K |
| K0040 |
Adjustable angle footplate |
277 |
244 |
$26K |
| A6212 |
Foam drg <=16 sq in w/border |
143 |
139 |
$23K |
| E0955 |
Cushioned headrest |
147 |
133 |
$22K |
| K0739 |
Repair/svc dme non-oxygen eq |
134 |
126 |
$21K |
| A7003 |
Nebulizer administration set |
5,780 |
1,048 |
$16K |
| E0956 |
W/c lateral trunk/hip suppor |
185 |
97 |
$15K |
| E0960 |
W/c shoulder harness/straps |
248 |
222 |
$15K |
| A4217 |
Sterile water/saline, 500 ml |
1,007 |
816 |
$15K |
| E0950 |
Tray |
222 |
191 |
$14K |
| A4553 |
Nondisp underpads, all sizes |
396 |
379 |
$14K |
| E0973 |
W/ch access det adj armrest |
125 |
113 |
$12K |
| E0971 |
Wheelchair anti-tipping devi |
209 |
188 |
$11K |
| A4208 |
3 cc sterile syringe&needle |
1,604 |
1,494 |
$10K |
| T4524 |
Adult size brief/diaper xl |
59 |
45 |
$10K |
| T4543 |
Adult disp brief/diap abv xl |
56 |
48 |
$9K |
| A4206 |
1 cc sterile syringe&needle |
1,443 |
1,342 |
$8K |
| A4459 |
Transanal irrigation, any |
69 |
43 |
$7K |
| A7013 |
Disposable compressor filter |
7,200 |
2,774 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
272 |
245 |
$6K |
| E0240 |
Bath/shower chair |
13 |
12 |
$4K |
| E2231 |
Solid seat support base |
28 |
28 |
$4K |
| K0070 |
Rr whl compl pne tire rep ea |
12 |
12 |
$3K |
| A7001 |
Nondisposable pump canister |
77 |
57 |
$3K |
| E0951 |
Loop heel |
120 |
97 |
$3K |
| A7526 |
Tracheostomy tube collar |
45 |
39 |
$2K |
| E0990 |
Wheelchair elevating leg res |
18 |
18 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
293 |
213 |
$2K |
| E0952 |
Toe loop/holder, each |
79 |
72 |
$2K |
| E0776 |
Iv pole |
17 |
12 |
$2K |
| E0957 |
W/c medial thigh support |
21 |
20 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
1,322 |
220 |
$2K |
| B4087 |
Gastro/jejuno tube, std |
41 |
16 |
$884.64 |
| T4531 |
Ped size pull-on sm/med |
12 |
12 |
$793.44 |
| A4332 |
Lube sterile packet |
51 |
49 |
$719.02 |
| E2213 |
Pneumatic prop tire insert |
18 |
15 |
$656.00 |
| E2211 |
Pneumatic propulsion tire |
19 |
15 |
$651.00 |
| A5120 |
Skin barrier, wipe or swab |
43 |
39 |
$414.27 |