| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
12,273 |
11,238 |
$437K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,423 |
4,980 |
$321K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
11,706 |
6,182 |
$297K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,027 |
1,884 |
$274K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,067 |
1,903 |
$253K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,495 |
1,313 |
$199K |
| T4541 |
Incontinence product, disposable underpad, large, each |
4,417 |
4,103 |
$198K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,739 |
2,226 |
$197K |
| 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 |
1,316 |
1,109 |
$177K |
| 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 |
1,133 |
913 |
$147K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,127 |
1,056 |
$145K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
3,243 |
2,929 |
$142K |
| B9998 |
Noc for enteral supplies |
1,113 |
431 |
$124K |
| A4927 |
Gloves, non-sterile, per 100 |
6,435 |
5,713 |
$113K |
| 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 |
619 |
456 |
$100K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
2,697 |
2,058 |
$86K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
7,903 |
4,034 |
$76K |
| E1392 |
Portable oxygen concentrator, rental |
1,909 |
1,537 |
$53K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
255 |
198 |
$48K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
81 |
74 |
$46K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
358 |
315 |
$43K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
330 |
275 |
$33K |
| A4335 |
Incontinence supply; miscellaneous |
2,273 |
1,331 |
$17K |
| A4322 |
Irrigation syringe, bulb or piston, each |
328 |
251 |
$14K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
106 |
91 |
$12K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
42 |
39 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
412 |
312 |
$5K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
117 |
101 |
$4K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
49 |
36 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
665 |
628 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
53 |
53 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
176 |
129 |
$2K |
| E0601 |
Continuous positive airway pressure (cpap) device |
18 |
15 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
59 |
40 |
$495.85 |
| A4657 |
Syringe, with or without needle, each |
16 |
12 |
$397.63 |
| A7031 |
Face mask interface, replacement for full face mask, each |
13 |
13 |
$397.07 |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
229 |
186 |
$369.76 |
| A7000 |
Canister, disposable, used with suction pump, each |
30 |
26 |
$361.44 |
| A7002 |
Tubing, used with suction pump, each |
64 |
51 |
$349.81 |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$303.63 |
| A7035 |
Headgear used with positive airway pressure device |
13 |
12 |
$259.76 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
20 |
14 |
$236.94 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
59 |
36 |
$186.79 |