| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
5,099 |
4,291 |
$720K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
9,395 |
8,043 |
$445K |
| E0147 |
Walker, heavy duty, multiple braking system, variable wheel resistance |
1,021 |
1,008 |
$101K |
| 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 |
2,110 |
1,963 |
$92K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,415 |
2,239 |
$64K |
| A4554 |
Disposable underpads, all sizes |
7,592 |
6,234 |
$55K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
636 |
467 |
$26K |
| A4670 |
Automatic blood pressure monitor |
860 |
846 |
$20K |
| E0245 |
Tub stool or bench |
1,292 |
1,271 |
$20K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
40 |
40 |
$14K |
| A4927 |
Gloves, non-sterile, per 100 |
2,663 |
2,330 |
$11K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
265 |
203 |
$11K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
607 |
602 |
$10K |
| 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 |
472 |
456 |
$8K |
| E0244 |
Raised toilet seat |
394 |
390 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
426 |
416 |
$6K |
| E0241 |
Bath tub wall rail, each |
448 |
431 |
$6K |
| E0156 |
Seat attachment, walker |
1,378 |
1,316 |
$5K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
110 |
104 |
$5K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
471 |
467 |
$4K |
| E0305 |
Bed side rails, half length |
76 |
75 |
$3K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,710 |
2,287 |
$3K |
| E1399 |
Durable medical equipment, miscellaneous |
1,571 |
1,399 |
$2K |
| 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 |
64 |
59 |
$1K |
| E0246 |
Transfer tub rail attachment |
28 |
26 |
$1K |
| E0570 |
Nebulizer, with compressor |
44 |
41 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
2,042 |
1,678 |
$743.42 |
| E0705 |
Transfer device, any type, each |
28 |
28 |
$689.08 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
81 |
61 |
$81.07 |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
27 |
27 |
$65.07 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
13 |
12 |
$26.85 |
| T4541 |
Incontinence product, disposable underpad, large, each |
13 |
12 |
$13.23 |