| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,994 |
2,544 |
$157K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,928 |
3,555 |
$144K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,267 |
741 |
$123K |
| E0570 |
Nebulizer, with compressor |
5,004 |
2,887 |
$98K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
764 |
535 |
$91K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,008 |
906 |
$82K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
668 |
375 |
$76K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,462 |
703 |
$56K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,540 |
2,138 |
$51K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
506 |
302 |
$45K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,542 |
697 |
$34K |
| K0001 |
Standard wheelchair |
7,027 |
3,711 |
$32K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,146 |
646 |
$31K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
469 |
215 |
$27K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
909 |
516 |
$18K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
983 |
456 |
$17K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,230 |
2,567 |
$15K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,093 |
636 |
$14K |
| A5120 |
Skin barrier, wipes or swabs, each |
4,358 |
2,120 |
$12K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,685 |
836 |
$12K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,990 |
1,506 |
$10K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
438 |
235 |
$9K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,590 |
859 |
$8K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
124 |
80 |
$8K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
491 |
171 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
424 |
237 |
$7K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
313 |
151 |
$6K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
609 |
392 |
$6K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
178 |
100 |
$6K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,683 |
726 |
$5K |
| 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 |
105 |
63 |
$4K |
| 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 |
123 |
52 |
$3K |
| B9002 |
Enteral nutrition infusion pump, any type |
256 |
105 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
56 |
40 |
$889.93 |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
276 |
179 |
$864.33 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
421 |
328 |
$736.80 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
62 |
24 |
$601.63 |
| A4367 |
Ostomy belt, each |
153 |
105 |
$492.77 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
66 |
48 |
$211.84 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
585 |
389 |
$179.12 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
100 |
73 |
$178.74 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
47 |
26 |
$148.33 |
| E0776 |
Iv pole |
42 |
24 |
$130.61 |
| E0156 |
Seat attachment, walker |
20 |
14 |
$61.79 |