| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,740 |
6,215 |
$683K |
| A4554 |
Disposable underpads, all sizes |
14,042 |
12,684 |
$624K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,060 |
4,633 |
$467K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,654 |
3,323 |
$331K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,252 |
1,987 |
$295K |
| 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 |
1,599 |
1,271 |
$173K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
691 |
476 |
$151K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
2,853 |
2,473 |
$110K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
882 |
782 |
$100K |
| E0570 |
Nebulizer, with compressor |
3,465 |
2,359 |
$94K |
| A4670 |
Automatic blood pressure monitor |
1,502 |
1,227 |
$73K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
714 |
666 |
$72K |
| K0003 |
Lightweight wheelchair |
4,351 |
2,727 |
$67K |
| 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 |
987 |
780 |
$65K |
| A4927 |
Gloves, non-sterile, per 100 |
2,495 |
2,228 |
$58K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
552 |
484 |
$50K |
| 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 |
401 |
306 |
$46K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,232 |
943 |
$40K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,624 |
1,589 |
$37K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
170 |
123 |
$10K |
| A4614 |
Peak expiratory flow rate meter, hand held |
438 |
401 |
$9K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
328 |
226 |
$8K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,298 |
1,654 |
$7K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
44 |
38 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
55 |
40 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
48 |
42 |
$2K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
18 |
15 |
$1K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
15 |
15 |
$1K |
| B9998 |
Noc for enteral supplies |
80 |
66 |
$1K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
77 |
49 |
$1K |
| A4259 |
Lancets, per box of 100 |
1,406 |
1,058 |
$952.95 |
| E0156 |
Seat attachment, walker |
167 |
127 |
$880.88 |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
44 |
42 |
$389.76 |
| E0325 |
Urinal; male, jug-type, any material |
44 |
31 |
$156.09 |
| A7015 |
Aerosol mask, used with dme nebulizer |
40 |
38 |
$69.54 |
| 90686 |
|
26 |
26 |
$0.00 |
| W4211 |
|
35 |
35 |
$0.00 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
29 |
20 |
$0.00 |