| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
13,130 |
12,101 |
$791K |
| A4927 |
Gloves, non-sterile, per 100 |
12,265 |
11,449 |
$477K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,364 |
3,144 |
$475K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,353 |
6,242 |
$450K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,197 |
2,978 |
$449K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,723 |
2,560 |
$347K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,511 |
1,361 |
$282K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,898 |
4,852 |
$236K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,501 |
1,388 |
$191K |
| 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 |
2,255 |
1,460 |
$130K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
771 |
721 |
$105K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,455 |
2,804 |
$98K |
| 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 |
6,609 |
4,958 |
$96K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,396 |
1,188 |
$94K |
| 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 |
1,103 |
571 |
$80K |
| K0001 |
Standard wheelchair |
4,667 |
3,093 |
$59K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
267 |
254 |
$53K |
| 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 |
586 |
361 |
$49K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
308 |
260 |
$34K |
| E0570 |
Nebulizer, with compressor |
3,632 |
2,436 |
$33K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
921 |
760 |
$30K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
199 |
178 |
$27K |
| A7037 |
Tubing used with positive airway pressure device |
2,100 |
1,756 |
$26K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,028 |
899 |
$26K |
| A7035 |
Headgear used with positive airway pressure device |
1,589 |
1,326 |
$22K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
106 |
99 |
$13K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
387 |
267 |
$10K |
| E0156 |
Seat attachment, walker |
1,262 |
1,019 |
$7K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
292 |
238 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
948 |
647 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
41 |
38 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
814 |
699 |
$1K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
23 |
12 |
$1K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
13 |
12 |
$862.28 |
| A7015 |
Aerosol mask, used with dme nebulizer |
693 |
585 |
$829.61 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
189 |
156 |
$772.74 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
579 |
501 |
$260.87 |
| A4335 |
Incontinence supply; miscellaneous |
31 |
31 |
$244.20 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14 |
14 |
$71.22 |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
12 |
12 |
$0.00 |