| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,498 |
2,182 |
$152K |
| A4554 |
Disposable underpads, all sizes |
2,844 |
2,415 |
$118K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,858 |
1,835 |
$85K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
652 |
595 |
$74K |
| 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 |
618 |
487 |
$41K |
| A7030 |
Full face mask used with positive airway pressure device, each |
870 |
555 |
$39K |
| T2025 |
Waiver services; not otherwise specified (nos) |
1,258 |
405 |
$31K |
| 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 |
2,530 |
1,538 |
$24K |
| 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 |
354 |
173 |
$19K |
| K0001 |
Standard wheelchair |
1,739 |
1,020 |
$17K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
884 |
503 |
$16K |
| E0570 |
Nebulizer, with compressor |
1,354 |
793 |
$15K |
| A7037 |
Tubing used with positive airway pressure device |
1,162 |
740 |
$11K |
| A4927 |
Gloves, non-sterile, per 100 |
514 |
403 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,199 |
1,397 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
182 |
119 |
$2K |
| A4670 |
Automatic blood pressure monitor |
29 |
24 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
100 |
68 |
$1K |