| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,826 |
1,775 |
$274K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,779 |
2,472 |
$135K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
898 |
797 |
$123K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
760 |
697 |
$98K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
711 |
662 |
$78K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
587 |
551 |
$72K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
730 |
676 |
$72K |
| E0570 |
Nebulizer, with compressor |
5,001 |
4,698 |
$54K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,223 |
1,094 |
$52K |
| 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 |
331 |
292 |
$27K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,277 |
1,218 |
$25K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
454 |
430 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
1,759 |
1,327 |
$18K |
| A7037 |
Tubing used with positive airway pressure device |
860 |
778 |
$12K |
| A7030 |
Full face mask used with positive airway pressure device, each |
163 |
150 |
$12K |
| K0001 |
Standard wheelchair |
655 |
575 |
$11K |
| A7035 |
Headgear used with positive airway pressure device |
615 |
563 |
$8K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
758 |
708 |
$6K |
| 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 |
14 |
14 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
39 |
38 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
301 |
270 |
$2K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
12 |
12 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
126 |
117 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
424 |
383 |
$683.44 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
16 |
13 |
$611.76 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
37 |
31 |
$499.14 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
16 |
14 |
$184.41 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
12 |
12 |
$141.10 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
13 |
12 |
$57.36 |