| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
9,515 |
9,381 |
$486K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,070 |
3,039 |
$256K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,457 |
2,411 |
$139K |
| A4335 |
Incontinence supply; miscellaneous |
6,414 |
6,275 |
$126K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,466 |
1,458 |
$117K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,974 |
4,965 |
$105K |
| 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 |
905 |
904 |
$85K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
762 |
754 |
$83K |
| A4927 |
Gloves, non-sterile, per 100 |
10,773 |
10,718 |
$60K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,641 |
2,629 |
$51K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
4,257 |
4,209 |
$29K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
723 |
718 |
$17K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
97 |
97 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
210 |
208 |
$12K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
72 |
70 |
$11K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
275 |
275 |
$10K |
| A5120 |
Skin barrier, wipes or swabs, each |
482 |
482 |
$9K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
172 |
169 |
$9K |
| A4402 |
Lubricant, per ounce |
720 |
718 |
$8K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
78 |
76 |
$7K |
| A4217 |
Sterile water/saline, 500 ml |
531 |
496 |
$5K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
26 |
26 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
302 |
281 |
$4K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
25 |
25 |
$3K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
14 |
14 |
$3K |
| A7000 |
Canister, disposable, used with suction pump, each |
136 |
133 |
$2K |
| A4259 |
Lancets, per box of 100 |
263 |
263 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
13 |
13 |
$792.11 |
| A4245 |
Alcohol wipes, per box |
467 |
467 |
$628.78 |
| A7002 |
Tubing, used with suction pump, each |
118 |
104 |
$568.02 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
160 |
151 |
$405.92 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
12 |
12 |
$255.99 |