| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,356 |
4,688 |
$175K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,489 |
1,764 |
$132K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,205 |
3,030 |
$126K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,269 |
2,367 |
$101K |
| 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 |
1,670 |
1,062 |
$94K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,662 |
1,218 |
$77K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,442 |
1,107 |
$63K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,246 |
1,725 |
$55K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,330 |
2,307 |
$45K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,276 |
2,368 |
$31K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
216 |
154 |
$29K |
| A7030 |
Full face mask used with positive airway pressure device, each |
545 |
385 |
$22K |
| K0001 |
Standard wheelchair |
1,283 |
987 |
$21K |
| A7035 |
Headgear used with positive airway pressure device |
1,416 |
979 |
$16K |
| E0570 |
Nebulizer, with compressor |
622 |
434 |
$16K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
924 |
599 |
$12K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
768 |
515 |
$11K |
| A4927 |
Gloves, non-sterile, per 100 |
827 |
659 |
$10K |
| A7031 |
Face mask interface, replacement for full face mask, each |
414 |
269 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,308 |
1,510 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
147 |
109 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
16 |
12 |
$999.18 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
12 |
12 |
$517.51 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
21 |
14 |
$319.88 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
54 |
44 |
$145.47 |