| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
5,077 |
5,062 |
$738K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,984 |
2,968 |
$713K |
| 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 |
4,798 |
4,099 |
$621K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,222 |
4,169 |
$393K |
| K0001 |
Standard wheelchair |
4,919 |
4,899 |
$189K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,850 |
1,847 |
$182K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,923 |
1,919 |
$168K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,719 |
2,705 |
$141K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,546 |
2,528 |
$138K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
714 |
710 |
$124K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
616 |
605 |
$113K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,105 |
4,058 |
$103K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
698 |
692 |
$94K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,471 |
3,451 |
$80K |
| K0003 |
Lightweight wheelchair |
1,067 |
1,064 |
$68K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
518 |
517 |
$65K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,241 |
1,230 |
$64K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
1,078 |
1,061 |
$64K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,258 |
3,243 |
$58K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
541 |
531 |
$51K |
| E0277 |
Powered pressure-reducing air mattress |
94 |
85 |
$34K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
663 |
661 |
$31K |
| A4670 |
Automatic blood pressure monitor |
611 |
608 |
$31K |
| A7000 |
Canister, disposable, used with suction pump, each |
830 |
777 |
$23K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,270 |
1,267 |
$18K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,251 |
2,241 |
$17K |
| A4322 |
Irrigation syringe, bulb or piston, each |
161 |
151 |
$14K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
642 |
607 |
$12K |
| E0305 |
Bed side rails, half length |
1,218 |
1,203 |
$12K |
| E0147 |
Walker, heavy duty, multiple braking system, variable wheel resistance |
50 |
50 |
$11K |
| E0272 |
Mattress, foam rubber |
994 |
978 |
$11K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
114 |
114 |
$11K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
651 |
608 |
$10K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
92 |
92 |
$10K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,632 |
3,610 |
$10K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
105 |
103 |
$9K |
| A7002 |
Tubing, used with suction pump, each |
699 |
653 |
$9K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
120 |
120 |
$8K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
88 |
88 |
$8K |
| A7035 |
Headgear used with positive airway pressure device |
250 |
250 |
$8K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,171 |
2,162 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
215 |
215 |
$7K |
| A7526 |
Tracheostomy tube collar/holder, each |
51 |
48 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
397 |
397 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
92 |
87 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
105 |
105 |
$3K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
50 |
50 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
831 |
822 |
$2K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13 |
12 |
$2K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
13 |
13 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
138 |
137 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
12 |
12 |
$1K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
12 |
12 |
$736.02 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
12 |
12 |
$144.12 |