| 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 |
1,837 |
1,492 |
$61K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
751 |
316 |
$21K |
| B4100 |
Food thickener, administered orally, per ounce |
97 |
85 |
$11K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
196 |
172 |
$9K |
| 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 |
72 |
50 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
723 |
563 |
$5K |
| A4930 |
Gloves, sterile, per pair |
301 |
283 |
$5K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
181 |
174 |
$4K |
| 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 |
60 |
38 |
$3K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
207 |
178 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
622 |
604 |
$1K |
| E0570 |
Nebulizer, with compressor |
188 |
125 |
$768.53 |
| A7035 |
Headgear used with positive airway pressure device |
39 |
39 |
$744.26 |
| K0001 |
Standard wheelchair |
91 |
62 |
$510.63 |
| E0601 |
Continuous positive airway pressure (cpap) device |
12 |
12 |
$477.31 |
| A7015 |
Aerosol mask, used with dme nebulizer |
54 |
53 |
$202.13 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
15 |
13 |
$182.37 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
54 |
53 |
$37.22 |