| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,741 |
1,622 |
$242K |
| A4554 |
Disposable underpads, all sizes |
3,923 |
3,578 |
$220K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,282 |
1,172 |
$180K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,473 |
1,333 |
$169K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,145 |
1,413 |
$137K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,480 |
2,370 |
$122K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,536 |
1,042 |
$84K |
| 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 |
1,040 |
657 |
$69K |
| E0570 |
Nebulizer, with compressor |
1,875 |
1,052 |
$28K |
| A7037 |
Tubing used with positive airway pressure device |
2,388 |
1,626 |
$26K |
| A4927 |
Gloves, non-sterile, per 100 |
981 |
901 |
$19K |
| A7035 |
Headgear used with positive airway pressure device |
1,323 |
930 |
$17K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
908 |
600 |
$15K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,065 |
2,114 |
$8K |
| 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 |
41 |
39 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
222 |
169 |
$6K |
| 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 |
24 |
24 |
$3K |
| K0001 |
Standard wheelchair |
256 |
146 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
16 |
13 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
78 |
53 |
$2K |
| A4335 |
Incontinence supply; miscellaneous |
267 |
260 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
74 |
50 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
49 |
37 |
$89.38 |
| A7015 |
Aerosol mask, used with dme nebulizer |
55 |
36 |
$54.92 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
19 |
12 |
$26.57 |