| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
65,797 |
59,801 |
$3.44M |
| T4527 |
Adult size pull-on lg |
22,344 |
20,613 |
$2.54M |
| T4526 |
Adult size pull-on med |
16,856 |
15,335 |
$1.77M |
| T4528 |
Adult size pull-on xl |
15,112 |
13,977 |
$1.60M |
| B4150 |
Ef complet w/intact nutrient |
18,204 |
16,241 |
$1.56M |
| A4927 |
Non-sterile gloves |
50,242 |
45,246 |
$1.43M |
| B4154 |
Ef spec metabolic noninherit |
10,560 |
9,477 |
$1.21M |
| T4544 |
Adlt disp und/pull on abv xl |
5,776 |
5,417 |
$866K |
| T4523 |
Adult size brief/diaper lg |
5,364 |
4,825 |
$588K |
| T4522 |
Adult size brief/diaper med |
5,317 |
4,531 |
$549K |
| T4524 |
Adult size brief/diaper xl |
3,858 |
3,440 |
$444K |
| T4543 |
Adult disp brief/diap abv xl |
2,510 |
2,317 |
$430K |
| T4525 |
Adult size pull-on sm |
3,923 |
3,431 |
$399K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,263 |
2,357 |
$346K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,205 |
2,627 |
$336K |
| S5165 |
Home modifications per serv |
882 |
678 |
$314K |
| E1390 |
Oxygen concentrator |
6,721 |
4,451 |
$295K |
| T4534 |
Youth size pull-on |
2,219 |
1,948 |
$270K |
| E0260 |
Hosp bed semi-electr w/ matt |
8,725 |
5,331 |
$266K |
| T4535 |
Disposable liner/shield/pad |
5,966 |
5,448 |
$224K |
| B4035 |
Enteral feed supp pump per d |
1,463 |
756 |
$167K |
| A4351 |
Straight tip urine catheter |
1,389 |
874 |
$139K |
| E0601 |
Cont airway pressure device |
3,028 |
2,170 |
$121K |
| T2025 |
Waiver service, nos |
2,763 |
2,324 |
$108K |
| K0001 |
Standard wheelchair |
8,904 |
5,336 |
$96K |
| T4521 |
Adult size brief/diaper sm |
888 |
730 |
$96K |
| E0570 |
Nebulizer with compression |
7,204 |
4,281 |
$82K |
| E0630 |
Patient lift hydraulic |
2,191 |
1,302 |
$69K |
| E0431 |
Portable gaseous 02 |
6,243 |
4,087 |
$44K |
| E0143 |
Walker folding wheeled w/o s |
1,420 |
938 |
$36K |
| A7030 |
Cpap full face mask |
557 |
356 |
$31K |
| T4530 |
Ped size brief/diaper lg |
372 |
295 |
$28K |
| B4034 |
Enter feed supkit syr by day |
586 |
272 |
$27K |
| E0240 |
Bath/shower chair |
312 |
280 |
$18K |
| E0562 |
Humidifier heated used w pap |
266 |
165 |
$16K |
| E0181 |
Press pad alternating w/ pum |
2,548 |
1,715 |
$16K |
| A7037 |
Pos airway pressure tubing |
1,004 |
684 |
$13K |
| A4928 |
Surgical mask |
662 |
623 |
$12K |
| B9998 |
Enteral supp not otherwise c |
728 |
552 |
$10K |
| A7035 |
Pos airway press headgear |
753 |
531 |
$10K |
| A4357 |
Bedside drainage bag |
1,710 |
954 |
$10K |
| E0163 |
Commode chair with fixed arm |
267 |
158 |
$6K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
171 |
75 |
$4K |
| A7015 |
Aerosol mask used w nebulize |
2,483 |
1,738 |
$3K |
| A7003 |
Nebulizer administration set |
2,700 |
1,826 |
$3K |
| A7031 |
Replacement facemask interfa |
196 |
111 |
$3K |
| A7038 |
Pos airway pressure filter |
1,271 |
846 |
$3K |
| E0156 |
Walker seat attachment |
634 |
360 |
$3K |
| A4253 |
Blood glucose/reagent strips |
796 |
475 |
$3K |
| B4088 |
Gastro/jejuno tube, low-pro |
36 |
24 |
$3K |
| A4670 |
Automatic bp monitor, dial |
43 |
41 |
$3K |
| A7002 |
Tubing used w suction pump |
574 |
334 |
$2K |
| A5120 |
Skin barrier, wipe or swab |
543 |
290 |
$1K |
| A4406 |
Pectin based ostomy paste |
160 |
86 |
$988.68 |
| A7034 |
Nasal application device |
19 |
12 |
$888.50 |
| E0910 |
Trapeze bar attached to bed |
183 |
126 |
$842.26 |
| A7000 |
Disposable canister for pump |
71 |
49 |
$709.67 |
| A7013 |
Disposable compressor filter |
1,636 |
1,121 |
$556.38 |
| A4628 |
Oropharyngeal suction cath |
69 |
49 |
$472.70 |
| A4259 |
Lancets per box |
602 |
356 |
$137.83 |
| X9999 |
|
23 |
22 |
$0.00 |