| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
6,031 |
4,703 |
$3.76M |
| B4035 |
Enteral feed supp pump per d |
16,838 |
12,820 |
$2.11M |
| E1390 |
Oxygen concentrator |
47,272 |
35,961 |
$1.61M |
| E0466 |
Home vent non-invasive inter |
2,820 |
2,277 |
$1.08M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
5,607 |
4,284 |
$1.01M |
| B4149 |
Ef blenderized foods |
1,616 |
1,371 |
$623K |
| E0445 |
Oximeter non-invasive |
6,019 |
4,933 |
$616K |
| B4152 |
Ef calorie dense>/=1.5kcal |
6,929 |
5,107 |
$480K |
| E0601 |
Cont airway pressure device |
11,635 |
9,013 |
$349K |
| B4153 |
Ef hydrolyzed/amino acids |
1,104 |
823 |
$346K |
| A7030 |
Cpap full face mask |
6,881 |
5,160 |
$346K |
| B4154 |
Ef spec metabolic noninherit |
1,546 |
1,144 |
$331K |
| A7031 |
Replacement facemask interfa |
10,530 |
8,487 |
$298K |
| B9002 |
Enter nutr inf pump any type |
5,872 |
4,842 |
$293K |
| B4034 |
Enter feed supkit syr by day |
4,688 |
3,515 |
$288K |
| E0465 |
Home vent invasive interface |
446 |
280 |
$264K |
| A4604 |
Tubing with heating element |
7,450 |
5,880 |
$190K |
| A7034 |
Nasal application device |
5,705 |
4,296 |
$174K |
| A7032 |
Replacement nasal cushion |
5,607 |
4,529 |
$169K |
| B4150 |
Ef complet w/intact nutrient |
3,629 |
2,617 |
$164K |
| E0431 |
Portable gaseous 02 |
19,454 |
14,895 |
$146K |
| E0562 |
Humidifier heated used w pap |
12,159 |
9,701 |
$137K |
| B4158 |
Ef ped complete intact nut |
747 |
555 |
$116K |
| E0600 |
Suction pump portab hom modl |
3,598 |
2,925 |
$99K |
| K0738 |
Portable gas oxygen system |
7,271 |
5,452 |
$80K |
| A7035 |
Pos airway press headgear |
7,447 |
5,642 |
$78K |
| A7033 |
Replacement nasal pillows |
3,292 |
2,650 |
$78K |
| A7038 |
Pos airway pressure filter |
21,112 |
16,809 |
$72K |
| E1392 |
Portable oxygen concentrator |
7,456 |
5,689 |
$71K |
| E0570 |
Nebulizer with compression |
9,417 |
6,734 |
$71K |
| B4088 |
Gastro/jejuno tube, low-pro |
4,023 |
3,329 |
$64K |
| E0470 |
Rad w/o backup non-inv intfc |
830 |
618 |
$57K |
| A4624 |
Tracheal suction tube |
729 |
512 |
$51K |
| A7046 |
Repl water chamber, pap dev |
6,307 |
4,627 |
$39K |
| E0434 |
Portable liquid 02 |
3,293 |
2,591 |
$39K |
| B4100 |
Food thickener oral |
619 |
481 |
$36K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,372 |
1,643 |
$35K |
| A7526 |
Tracheostomy tube collar |
882 |
660 |
$35K |
| B4036 |
Enteral feed sup kit grav by |
494 |
334 |
$34K |
| A7037 |
Pos airway pressure tubing |
5,365 |
3,787 |
$32K |
| A4629 |
Tracheostomy care kit |
757 |
530 |
$31K |
| E0776 |
Iv pole |
4,049 |
3,418 |
$31K |
| E0619 |
Apnea monitor w recorder |
250 |
212 |
$27K |
| B4155 |
Ef incomplete/modular |
759 |
582 |
$25K |
| A7000 |
Disposable canister for pump |
1,423 |
1,078 |
$23K |
| E0143 |
Walker folding wheeled w/o s |
774 |
676 |
$22K |
| E0439 |
Stationary liquid 02 |
546 |
426 |
$22K |
| E1150 |
Wheelchair standard w/ leg r |
498 |
408 |
$15K |
| A4483 |
Moisture exchanger |
201 |
145 |
$13K |
| E1130 |
Whlchr stand fxd arm ft rest |
426 |
355 |
$13K |
| E0565 |
Compressor air power source |
393 |
329 |
$10K |
| B4082 |
Enteral ng tubing w/o stylet |
335 |
250 |
$8K |
| A7520 |
Trach/laryn tube non-cuffed |
507 |
335 |
$8K |
| B9998 |
Enteral supp not otherwise c |
431 |
358 |
$8K |
| A7002 |
Tubing used w suction pump |
630 |
493 |
$4K |
| E0550 |
Humidif extens supple w ippb |
112 |
111 |
$3K |
| A7005 |
Nondisposable nebulizer set |
369 |
307 |
$3K |
| A4606 |
Oxygen probe used w oximeter |
970 |
494 |
$3K |
| A7003 |
Nebulizer administration set |
3,131 |
2,337 |
$3K |
| A4628 |
Oropharyngeal suction cath |
241 |
203 |
$2K |
| A4618 |
Breathing circuits |
97 |
84 |
$2K |
| A4623 |
Tracheostomy inner cannula |
16 |
12 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
258 |
197 |
$1K |
| E0250 |
Hosp bed fixed ht w/ mattres |
116 |
64 |
$791.05 |
| K0001 |
Standard wheelchair |
450 |
385 |
$773.15 |
| A7015 |
Aerosol mask used w nebulize |
754 |
564 |
$479.01 |
| A7525 |
Tracheostomy mask |
535 |
310 |
$400.67 |
| E0156 |
Walker seat attachment |
32 |
25 |
$289.77 |
| A7036 |
Pos airway press chinstrap |
35 |
31 |
$264.66 |
| A7039 |
Filter, non disposable w pap |
193 |
126 |
$221.92 |
| A7013 |
Disposable compressor filter |
426 |
339 |
$154.20 |