| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
3,970 |
3,761 |
$182K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
224 |
109 |
$144K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,132 |
2,938 |
$119K |
| A4927 |
Gloves, non-sterile, per 100 |
4,138 |
3,815 |
$109K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
323 |
210 |
$49K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
448 |
320 |
$44K |
| A4217 |
Sterile water/saline, 500 ml |
675 |
517 |
$38K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
260 |
239 |
$33K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
208 |
165 |
$30K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
158 |
138 |
$30K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
193 |
187 |
$23K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
416 |
384 |
$22K |
| E0555 |
Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter |
300 |
112 |
$18K |
| S8189 |
Tracheostomy supply, not otherwise classified |
943 |
552 |
$17K |
| 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 |
122 |
88 |
$16K |
| K0001 |
Standard wheelchair |
675 |
628 |
$15K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
108 |
104 |
$13K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
97 |
85 |
$12K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
150 |
136 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
562 |
469 |
$11K |
| 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 |
86 |
68 |
$9K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
53 |
26 |
$9K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
425 |
331 |
$8K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
346 |
225 |
$7K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
42 |
39 |
$6K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
140 |
130 |
$6K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
172 |
129 |
$4K |
| A7526 |
Tracheostomy tube collar/holder, each |
50 |
38 |
$3K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
105 |
62 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
37 |
27 |
$2K |
| A7000 |
Canister, disposable, used with suction pump, each |
149 |
96 |
$1K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
63 |
57 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
55 |
43 |
$1K |
| A7002 |
Tubing, used with suction pump, each |
169 |
98 |
$666.05 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
88 |
66 |
$443.25 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
101 |
54 |
$283.04 |
| A9270 |
Non-covered item or service |
229 |
139 |
$200.04 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
19 |
12 |
$116.08 |
| A4657 |
Syringe, with or without needle, each |
29 |
24 |
$67.91 |
| A4245 |
Alcohol wipes, per box |
15 |
13 |
$51.39 |
| A7525 |
Tracheostomy mask, each |
29 |
24 |
$44.47 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
17 |
14 |
$30.81 |