| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
3,551 |
2,925 |
$726K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,268 |
1,064 |
$444K |
| B4149 |
Ef blenderized foods |
1,033 |
783 |
$273K |
| B4161 |
Ef ped hydrolyzed/amino acid |
246 |
212 |
$205K |
| B4034 |
Enter feed supkit syr by day |
1,631 |
1,385 |
$170K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,793 |
1,432 |
$131K |
| T4541 |
Large disposable underpad |
3,690 |
3,025 |
$121K |
| T4522 |
Adult size brief/diaper med |
1,220 |
1,021 |
$112K |
| T4526 |
Adult size pull-on med |
960 |
813 |
$72K |
| T4527 |
Adult size pull-on lg |
615 |
490 |
$46K |
| A4351 |
Straight tip urine catheter |
144 |
129 |
$17K |
| B9002 |
Enter nutr inf pump any type |
1,536 |
1,056 |
$17K |
| T4525 |
Adult size pull-on sm |
218 |
162 |
$15K |
| T4528 |
Adult size pull-on xl |
114 |
98 |
$9K |
| B9998 |
Enteral supp not otherwise c |
886 |
768 |
$9K |
| B4152 |
Ef calorie dense>/=1.5kcal |
90 |
49 |
$6K |
| K0800 |
Pov group 1 std up to 300lbs |
433 |
300 |
$6K |
| T4521 |
Adult size brief/diaper sm |
73 |
55 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
252 |
187 |
$3K |
| E0431 |
Portable gaseous 02 |
436 |
360 |
$2K |
| A4239 |
Non-adju cgm supply allow |
13 |
12 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
277 |
219 |
$1K |
| A4357 |
Bedside drainage bag |
77 |
65 |
$813.64 |
| A5120 |
Skin barrier, wipe or swab |
125 |
102 |
$810.65 |
| A4425 |
Ost pch drain for barrier fl |
12 |
12 |
$532.30 |
| K0823 |
Pwc gp 2 std cap chair |
16 |
12 |
$453.24 |
| A4456 |
Adhesive remover, wipes |
67 |
50 |
$449.67 |
| A4385 |
Ost skn barrier sld ext wear |
16 |
12 |
$438.28 |
| E0443 |
Portable 02 contents, gas |
35 |
24 |
$306.60 |
| E0156 |
Walker seat attachment |
50 |
41 |
$208.03 |
| A4209 |
5+ cc sterile syringe&needle |
51 |
36 |
$130.61 |
| A4358 |
Urinary leg or abdomen bag |
12 |
12 |
$108.42 |
| A4450 |
Non-waterproof tape |
147 |
128 |
$52.68 |
| A9276 |
Disposable sensor, cgm sys |
12 |
12 |
$0.00 |
| E1399 |
Durable medical equipment mi |
42 |
26 |
$0.00 |