| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
13,217 |
13,052 |
$679K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,736 |
3,731 |
$389K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,170 |
1,808 |
$365K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,002 |
6,770 |
$219K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,231 |
2,226 |
$179K |
| 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 |
1,111 |
1,000 |
$164K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,544 |
1,500 |
$156K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,255 |
2,253 |
$148K |
| K0001 |
Standard wheelchair |
11,368 |
10,873 |
$146K |
| 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 |
1,613 |
1,406 |
$142K |
| E0776 |
Iv pole |
2,891 |
2,735 |
$137K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,888 |
1,882 |
$115K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,910 |
3,854 |
$97K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,978 |
1,784 |
$95K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
857 |
845 |
$84K |
| A6224 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
810 |
743 |
$81K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
2,873 |
2,513 |
$60K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,996 |
1,857 |
$55K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,551 |
2,531 |
$51K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
482 |
482 |
$40K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
820 |
747 |
$33K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
941 |
888 |
$31K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
11,931 |
11,424 |
$31K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,875 |
6,642 |
$29K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,132 |
1,086 |
$19K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
759 |
757 |
$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 |
210 |
193 |
$14K |
| E0570 |
Nebulizer, with compressor |
4,161 |
4,016 |
$10K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
2,881 |
2,604 |
$8K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
943 |
922 |
$8K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
427 |
373 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
927 |
905 |
$7K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
392 |
385 |
$6K |
| A7002 |
Tubing, used with suction pump, each |
337 |
336 |
$6K |
| E0156 |
Seat attachment, walker |
1,818 |
1,804 |
$6K |
| E0245 |
Tub stool or bench |
102 |
102 |
$6K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
908 |
888 |
$5K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
760 |
734 |
$4K |
| S1015 |
Iv tubing extension set |
657 |
531 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
441 |
421 |
$2K |
| K0003 |
Lightweight wheelchair |
55 |
54 |
$1K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
26 |
26 |
$671.50 |
| A4335 |
Incontinence supply; miscellaneous |
77 |
77 |
$534.55 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
149 |
148 |
$533.45 |
| A4210 |
Needle-free injection device, each |
97 |
88 |
$528.62 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
91 |
91 |
$485.03 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
98 |
84 |
$403.97 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
96 |
94 |
$302.71 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
12 |
12 |
$193.44 |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
19 |
12 |
$147.00 |
| G0333 |
Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary |
17 |
16 |
$129.01 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
15 |
15 |
$127.32 |
| A7015 |
Aerosol mask, used with dme nebulizer |
121 |
121 |
$34.78 |