| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,050 |
2,594 |
$1.99M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,520 |
3,834 |
$165K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,140 |
1,819 |
$116K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,767 |
2,427 |
$110K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,382 |
1,210 |
$75K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,230 |
1,062 |
$60K |
| 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 |
3,043 |
1,307 |
$56K |
| 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 |
1,849 |
968 |
$37K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,971 |
2,335 |
$37K |
| B9002 |
Enteral nutrition infusion pump, any type |
313 |
297 |
$5K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
25 |
24 |
$368.20 |
| A4927 |
Gloves, non-sterile, per 100 |
13 |
13 |
$225.94 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
24 |
24 |
$91.53 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
26 |
26 |
$71.37 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
13 |
13 |
$40.43 |