| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,150 |
1,915 |
$311K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,070 |
1,851 |
$276K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,857 |
1,709 |
$260K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,153 |
2,029 |
$157K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,684 |
4,196 |
$122K |
| A4927 |
Gloves, non-sterile, per 100 |
3,346 |
3,088 |
$95K |
| 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 |
841 |
675 |
$68K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,828 |
1,730 |
$62K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,661 |
1,559 |
$54K |
| A7030 |
Full face mask used with positive airway pressure device, each |
994 |
935 |
$51K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,045 |
1,864 |
$44K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,397 |
1,258 |
$37K |
| E0570 |
Nebulizer, with compressor |
499 |
496 |
$27K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
522 |
478 |
$27K |
| 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 |
160 |
147 |
$21K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
591 |
586 |
$20K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
580 |
539 |
$19K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
166 |
158 |
$12K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,483 |
2,277 |
$9K |
| A4335 |
Incontinence supply; miscellaneous |
2,673 |
2,453 |
$9K |
| A7035 |
Headgear used with positive airway pressure device |
750 |
687 |
$8K |
| K0003 |
Lightweight wheelchair |
65 |
61 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
509 |
463 |
$4K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
26 |
25 |
$4K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
515 |
490 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
227 |
226 |
$459.01 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
91 |
61 |
$127.54 |