| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
10,671 |
7,445 |
$977K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,676 |
4,122 |
$479K |
| T4541 |
Incontinence product, disposable underpad, large, each |
12,229 |
11,193 |
$465K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,886 |
4,395 |
$443K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,003 |
3,637 |
$337K |
| 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 |
3,014 |
2,533 |
$276K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
7,813 |
6,719 |
$252K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,001 |
1,766 |
$207K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,257 |
1,876 |
$186K |
| A4927 |
Gloves, non-sterile, per 100 |
10,827 |
9,952 |
$167K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,723 |
1,434 |
$149K |
| 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 |
1,146 |
871 |
$131K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,375 |
1,200 |
$126K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,435 |
1,226 |
$100K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,920 |
1,702 |
$96K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
416 |
401 |
$93K |
| 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 |
337 |
304 |
$60K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,557 |
1,292 |
$46K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
440 |
309 |
$31K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
206 |
184 |
$23K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
283 |
239 |
$11K |
| E0570 |
Nebulizer, with compressor |
723 |
689 |
$6K |
| E0601 |
Continuous positive airway pressure (cpap) device |
121 |
105 |
$5K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
53 |
53 |
$4K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
14 |
12 |
$4K |
| A4670 |
Automatic blood pressure monitor |
64 |
63 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
433 |
359 |
$2K |
| K0001 |
Standard wheelchair |
111 |
97 |
$1K |
| E0245 |
Tub stool or bench |
14 |
14 |
$621.00 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
96 |
77 |
$339.55 |
| A4259 |
Lancets, per box of 100 |
76 |
65 |
$30.76 |