| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
4,587 |
4,422 |
$608K |
| T4541 |
Incontinence product, disposable underpad, large, each |
4,156 |
4,041 |
$279K |
| 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 |
1,381 |
1,285 |
$189K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,287 |
1,240 |
$155K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,208 |
1,177 |
$143K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,188 |
2,117 |
$99K |
| E0570 |
Nebulizer, with compressor |
622 |
561 |
$44K |
| A4927 |
Gloves, non-sterile, per 100 |
2,581 |
2,492 |
$38K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
380 |
355 |
$38K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
180 |
179 |
$26K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,921 |
2,796 |
$25K |
| E0601 |
Continuous positive airway pressure (cpap) device |
427 |
392 |
$17K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
130 |
123 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
578 |
522 |
$11K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
991 |
959 |
$5K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
155 |
149 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
715 |
674 |
$932.34 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
437 |
432 |
$404.67 |
| A7031 |
Face mask interface, replacement for full face mask, each |
12 |
12 |
$357.78 |
| A7035 |
Headgear used with positive airway pressure device |
14 |
12 |
$188.65 |