| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
8,567 |
7,629 |
$449K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,963 |
2,691 |
$334K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,475 |
2,326 |
$302K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,743 |
1,487 |
$227K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,214 |
1,077 |
$149K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
962 |
894 |
$127K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
841 |
773 |
$93K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
704 |
639 |
$75K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
607 |
445 |
$69K |
| A4927 |
Gloves, non-sterile, per 100 |
3,589 |
3,246 |
$63K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,757 |
1,834 |
$62K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
258 |
205 |
$60K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
619 |
471 |
$54K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
370 |
337 |
$39K |
| A4335 |
Incontinence supply; miscellaneous |
2,036 |
1,945 |
$16K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
103 |
101 |
$9K |
| A7037 |
Tubing used with positive airway pressure device |
927 |
631 |
$8K |
| A7030 |
Full face mask used with positive airway pressure device, each |
207 |
138 |
$8K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
224 |
121 |
$7K |
| E0570 |
Nebulizer, with compressor |
318 |
210 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
403 |
284 |
$4K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
34 |
24 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,200 |
803 |
$2K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
214 |
105 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
322 |
121 |
$2K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
13 |
12 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
22 |
12 |
$1K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
41 |
24 |
$1K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
20 |
12 |
$415.35 |
| B9998 |
Noc for enteral supplies |
14 |
12 |
$91.70 |