| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
6,266 |
5,553 |
$262K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,368 |
2,894 |
$224K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,967 |
2,615 |
$162K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,412 |
3,041 |
$134K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
940 |
835 |
$128K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
987 |
852 |
$113K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,010 |
908 |
$112K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
227 |
216 |
$108K |
| 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 |
533 |
419 |
$98K |
| A4927 |
Gloves, non-sterile, per 100 |
3,325 |
2,775 |
$71K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
2,177 |
1,480 |
$67K |
| E1392 |
Portable oxygen concentrator, rental |
1,949 |
1,699 |
$44K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,309 |
1,142 |
$43K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
311 |
307 |
$38K |
| E0601 |
Continuous positive airway pressure (cpap) device |
643 |
566 |
$31K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
4,524 |
2,747 |
$28K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
244 |
185 |
$27K |
| K0001 |
Standard wheelchair |
697 |
662 |
$17K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
486 |
394 |
$17K |
| E0570 |
Nebulizer, with compressor |
904 |
831 |
$13K |
| A7031 |
Face mask interface, replacement for full face mask, each |
381 |
305 |
$13K |
| A7030 |
Full face mask used with positive airway pressure device, each |
136 |
110 |
$11K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
41 |
36 |
$8K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
17 |
12 |
$6K |
| 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 |
266 |
245 |
$5K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
28 |
27 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
223 |
173 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,027 |
853 |
$4K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
41 |
37 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
95 |
91 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
772 |
430 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
45 |
40 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
150 |
120 |
$967.88 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
18 |
16 |
$150.78 |