| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,729 |
2,690 |
$789K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,901 |
5,807 |
$658K |
| E1399 |
Durable medical equipment, miscellaneous |
532 |
404 |
$517K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,448 |
3,367 |
$374K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,680 |
1,613 |
$262K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,196 |
3,146 |
$221K |
| 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 |
755 |
727 |
$174K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
996 |
920 |
$156K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,477 |
6,346 |
$126K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,244 |
1,212 |
$89K |
| A4927 |
Gloves, non-sterile, per 100 |
4,001 |
3,712 |
$58K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
302 |
252 |
$57K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
2,669 |
2,625 |
$56K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
866 |
812 |
$43K |
| E0601 |
Continuous positive airway pressure (cpap) device |
358 |
322 |
$22K |
| K0001 |
Standard wheelchair |
804 |
791 |
$20K |
| 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 |
96 |
86 |
$13K |
| 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 |
646 |
630 |
$7K |
| E0570 |
Nebulizer, with compressor |
455 |
449 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
292 |
251 |
$6K |
| A4335 |
Incontinence supply; miscellaneous |
263 |
247 |
$5K |
| B9998 |
Noc for enteral supplies |
41 |
38 |
$4K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
13 |
13 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
127 |
124 |
$601.62 |
| W0137 |
|
123 |
123 |
$0.00 |