| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
76,614 |
69,786 |
$11.95M |
| E0784 |
External ambulatory infusion pump, insulin |
12,697 |
12,014 |
$6.96M |
| 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 |
37,030 |
34,542 |
$5.25M |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
46,959 |
42,574 |
$1.45M |
| T4541 |
Incontinence product, disposable underpad, large, each |
17,349 |
16,421 |
$1.17M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
6,823 |
6,658 |
$1.16M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,480 |
7,246 |
$1.04M |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
69,024 |
62,539 |
$989K |
| E0601 |
Continuous positive airway pressure (cpap) device |
18,623 |
16,606 |
$981K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
30,507 |
27,459 |
$909K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
6,187 |
6,000 |
$877K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,147 |
11,818 |
$576K |
| 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 |
5,659 |
5,185 |
$537K |
| 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 |
5,803 |
5,313 |
$408K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,301 |
2,970 |
$352K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
13,785 |
12,231 |
$331K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,194 |
2,947 |
$297K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,791 |
2,566 |
$278K |
| A5120 |
Skin barrier, wipes or swabs, each |
31,804 |
28,680 |
$238K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,481 |
1,415 |
$221K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,059 |
1,868 |
$214K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
5,464 |
4,941 |
$172K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,633 |
1,557 |
$167K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,176 |
1,038 |
$163K |
| A4927 |
Gloves, non-sterile, per 100 |
9,823 |
9,267 |
$132K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
5,019 |
4,730 |
$122K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,906 |
1,723 |
$118K |
| A7035 |
Headgear used with positive airway pressure device |
4,545 |
4,139 |
$101K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
799 |
776 |
$87K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,424 |
2,267 |
$85K |
| K0001 |
Standard wheelchair |
3,308 |
2,937 |
$80K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,051 |
1,834 |
$78K |
| E0570 |
Nebulizer, with compressor |
1,607 |
1,513 |
$55K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,239 |
8,351 |
$52K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
512 |
503 |
$41K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,293 |
1,227 |
$39K |
| A4670 |
Automatic blood pressure monitor |
565 |
523 |
$32K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
415 |
395 |
$23K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,266 |
1,205 |
$22K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,438 |
2,198 |
$20K |
| E1392 |
Portable oxygen concentrator, rental |
1,002 |
848 |
$19K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
542 |
468 |
$9K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
653 |
419 |
$8K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
247 |
224 |
$6K |
| E0156 |
Seat attachment, walker |
712 |
682 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
726 |
712 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
340 |
233 |
$5K |
| K0604 |
Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each |
297 |
267 |
$3K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
300 |
165 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
313 |
290 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
37 |
36 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
115 |
96 |
$1K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
15 |
14 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
385 |
339 |
$442.48 |
| E0245 |
Tub stool or bench |
12 |
12 |
$423.03 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
12 |
12 |
$345.42 |
| A4259 |
Lancets, per box of 100 |
494 |
491 |
$332.48 |
| A4217 |
Sterile water/saline, 500 ml |
21 |
12 |
$232.00 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
77 |
75 |
$207.89 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
17 |
12 |
$76.48 |