| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
9,189 |
7,905 |
$713K |
| A4554 |
Disposable underpads, all sizes |
12,204 |
11,214 |
$596K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,822 |
4,484 |
$580K |
| 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 |
6,182 |
4,616 |
$497K |
| 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 |
4,104 |
2,832 |
$455K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,603 |
3,393 |
$399K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,545 |
2,370 |
$304K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,287 |
1,082 |
$157K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,323 |
3,185 |
$134K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,054 |
908 |
$107K |
| 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 |
1,176 |
844 |
$102K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
543 |
528 |
$88K |
| A4927 |
Gloves, non-sterile, per 100 |
4,159 |
3,809 |
$81K |
| A4670 |
Automatic blood pressure monitor |
1,286 |
1,063 |
$66K |
| E0570 |
Nebulizer, with compressor |
1,010 |
785 |
$64K |
| T2025 |
Waiver services; not otherwise specified (nos) |
2,108 |
1,215 |
$60K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
405 |
386 |
$53K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
447 |
391 |
$47K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
448 |
378 |
$37K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
256 |
217 |
$31K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
245 |
238 |
$29K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
272 |
222 |
$19K |
| A4335 |
Incontinence supply; miscellaneous |
1,644 |
1,548 |
$12K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
493 |
454 |
$11K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
318 |
274 |
$7K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
171 |
81 |
$6K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
246 |
161 |
$4K |
| K0001 |
Standard wheelchair |
520 |
304 |
$4K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
25 |
22 |
$837.89 |
| A7015 |
Aerosol mask, used with dme nebulizer |
497 |
456 |
$815.39 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
425 |
399 |
$18.49 |