| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
10,563 |
9,723 |
$454K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,737 |
5,194 |
$342K |
| T4541 |
Incontinence product, disposable underpad, large, each |
7,905 |
7,530 |
$281K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,514 |
7,739 |
$266K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,887 |
3,553 |
$247K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,112 |
3,757 |
$229K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,895 |
3,760 |
$209K |
| 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 |
1,896 |
1,678 |
$172K |
| A4927 |
Gloves, non-sterile, per 100 |
8,941 |
8,507 |
$130K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,101 |
1,057 |
$97K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
540 |
488 |
$75K |
| A7035 |
Headgear used with positive airway pressure device |
1,942 |
1,881 |
$53K |
| A7037 |
Tubing used with positive airway pressure device |
1,802 |
1,763 |
$42K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
780 |
719 |
$41K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,010 |
962 |
$38K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
679 |
667 |
$36K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
164 |
141 |
$27K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,164 |
2,079 |
$11K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
142 |
131 |
$11K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
308 |
307 |
$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 |
42 |
39 |
$8K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
40 |
38 |
$4K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
43 |
38 |
$3K |
| 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 |
13 |
12 |
$1K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
13 |
13 |
$476.68 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
12 |
12 |
$339.09 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
226 |
221 |
$271.51 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
30 |
30 |
$270.60 |