| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,850 |
1,651 |
$159K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,004 |
1,957 |
$126K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,014 |
1,955 |
$109K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,414 |
1,386 |
$93K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,336 |
2,251 |
$86K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,314 |
2,261 |
$73K |
| E0570 |
Nebulizer, with compressor |
1,429 |
1,378 |
$66K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
1,579 |
1,317 |
$64K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
1,697 |
1,300 |
$54K |
| A4670 |
Automatic blood pressure monitor |
1,597 |
1,559 |
$54K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
177 |
176 |
$32K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
552 |
483 |
$22K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
555 |
449 |
$14K |
| A4927 |
Gloves, non-sterile, per 100 |
585 |
569 |
$7K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
110 |
108 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
141 |
137 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
340 |
323 |
$3K |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
43 |
43 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
89 |
88 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
164 |
160 |
$1K |
| E0156 |
Seat attachment, walker |
101 |
99 |
$860.97 |
| A4452 |
Tape, waterproof, per 18 square inches |
24 |
24 |
$218.54 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
39 |
29 |
$114.21 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
12 |
12 |
$107.61 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
13 |
12 |
$30.72 |