| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
5,942 |
2,665 |
$2.17M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,932 |
4,812 |
$1.30M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
4,337 |
1,522 |
$843K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
7,419 |
7,322 |
$748K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,228 |
2,105 |
$717K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,136 |
985 |
$606K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,927 |
5,859 |
$531K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,723 |
4,646 |
$521K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,317 |
1,225 |
$507K |
| T4541 |
Incontinence product, disposable underpad, large, each |
11,488 |
11,373 |
$464K |
| 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 |
739 |
718 |
$448K |
| A4927 |
Gloves, non-sterile, per 100 |
27,533 |
26,624 |
$408K |
| A4335 |
Incontinence supply; miscellaneous |
13,124 |
12,763 |
$383K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,019 |
3,955 |
$378K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,546 |
2,220 |
$354K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
9,413 |
9,342 |
$337K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,337 |
3,288 |
$327K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,818 |
2,741 |
$264K |
| 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 |
1,996 |
1,937 |
$264K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,360 |
2,316 |
$254K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,263 |
3,215 |
$224K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,485 |
2,458 |
$187K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,372 |
1,360 |
$187K |
| A4217 |
Sterile water/saline, 500 ml |
1,942 |
1,694 |
$172K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,638 |
1,545 |
$163K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,412 |
1,397 |
$148K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,072 |
2,039 |
$148K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
561 |
491 |
$146K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,715 |
2,569 |
$143K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,129 |
1,085 |
$139K |
| 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 |
841 |
823 |
$138K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,743 |
1,720 |
$125K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
1,913 |
1,587 |
$123K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,370 |
1,941 |
$119K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,151 |
3,737 |
$111K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,668 |
2,101 |
$109K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
176 |
111 |
$105K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
685 |
405 |
$98K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,305 |
994 |
$85K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
1,265 |
1,153 |
$80K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
382 |
288 |
$75K |
| B9002 |
Enteral nutrition infusion pump, any type |
783 |
733 |
$68K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,786 |
1,681 |
$68K |
| A7002 |
Tubing, used with suction pump, each |
4,447 |
3,894 |
$62K |
| S9999 |
Sales tax |
5,164 |
2,310 |
$61K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,734 |
2,280 |
$57K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
886 |
737 |
$55K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,684 |
2,566 |
$45K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,820 |
2,554 |
$44K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
322 |
263 |
$39K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,318 |
3,044 |
$38K |
| E0601 |
Continuous positive airway pressure (cpap) device |
361 |
327 |
$33K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
2,057 |
1,949 |
$32K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,421 |
1,247 |
$30K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
223 |
194 |
$30K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,334 |
1,293 |
$25K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
440 |
427 |
$21K |
| 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 |
135 |
134 |
$20K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
294 |
287 |
$19K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
109 |
107 |
$14K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
151 |
127 |
$13K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
414 |
402 |
$13K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
72 |
68 |
$10K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,557 |
1,290 |
$10K |
| A4332 |
Lubricant, individual sterile packet, each |
1,666 |
1,465 |
$8K |
| A4605 |
Tracheal suction catheter, closed system, each |
26 |
26 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,106 |
1,080 |
$7K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
169 |
164 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,587 |
1,315 |
$6K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
122 |
118 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
197 |
192 |
$5K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
1,593 |
1,430 |
$4K |
| K0040 |
Adjustable angle footplate, each |
60 |
53 |
$4K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
133 |
124 |
$4K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
13 |
13 |
$3K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
31 |
30 |
$2K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
25 |
13 |
$2K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
15 |
13 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
130 |
130 |
$2K |
| A7525 |
Tracheostomy mask, each |
750 |
642 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
181 |
160 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
16 |
16 |
$1K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
12 |
12 |
$1K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14 |
14 |
$1K |
| E0950 |
Wheelchair accessory, tray, each |
12 |
12 |
$951.21 |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
12 |
12 |
$736.51 |
| A4402 |
Lubricant, per ounce |
107 |
101 |
$656.17 |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
12 |
12 |
$321.51 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$169.66 |
| A4371 |
Ostomy skin barrier, powder, per oz |
28 |
24 |
$60.14 |