| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,401 |
2,124 |
$445K |
| 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 |
1,153 |
822 |
$208K |
| E0601 |
Continuous positive airway pressure (cpap) device |
970 |
871 |
$61K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
299 |
280 |
$49K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
996 |
928 |
$33K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
185 |
178 |
$22K |
| K0003 |
Lightweight wheelchair |
1,203 |
1,144 |
$21K |
| A7031 |
Face mask interface, replacement for full face mask, each |
416 |
393 |
$14K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
174 |
169 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
870 |
830 |
$5K |
| E0570 |
Nebulizer, with compressor |
243 |
238 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
102 |
98 |
$2K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
204 |
202 |
$1K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
628 |
593 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
29 |
28 |
$674.50 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
25 |
24 |
$119.06 |