| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
9,944 |
9,397 |
$355K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,920 |
5,287 |
$345K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,612 |
4,408 |
$263K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,647 |
5,353 |
$226K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,349 |
1,316 |
$194K |
| 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 |
1,133 |
867 |
$174K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
358 |
283 |
$171K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,374 |
1,351 |
$157K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,182 |
1,124 |
$150K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
959 |
919 |
$130K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
586 |
512 |
$128K |
| A4927 |
Gloves, non-sterile, per 100 |
5,379 |
4,778 |
$115K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
615 |
595 |
$72K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,892 |
1,712 |
$71K |
| 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 |
501 |
408 |
$68K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
320 |
312 |
$61K |
| A7030 |
Full face mask used with positive airway pressure device, each |
626 |
574 |
$58K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
6,768 |
4,482 |
$54K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,121 |
2,012 |
$53K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
355 |
349 |
$53K |
| E1392 |
Portable oxygen concentrator, rental |
2,879 |
2,632 |
$42K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
295 |
280 |
$38K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,085 |
939 |
$38K |
| 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 |
222 |
185 |
$34K |
| 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 |
1,469 |
1,315 |
$34K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
433 |
417 |
$31K |
| A7031 |
Face mask interface, replacement for full face mask, each |
861 |
773 |
$29K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,188 |
1,096 |
$20K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
104 |
65 |
$17K |
| E0570 |
Nebulizer, with compressor |
1,392 |
1,301 |
$16K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
124 |
117 |
$16K |
| A7035 |
Headgear used with positive airway pressure device |
740 |
686 |
$15K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
908 |
418 |
$15K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
413 |
392 |
$14K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
238 |
219 |
$14K |
| K0001 |
Standard wheelchair |
489 |
451 |
$9K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
84 |
84 |
$9K |
| A7000 |
Canister, disposable, used with suction pump, each |
506 |
455 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,957 |
1,735 |
$7K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
282 |
270 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
474 |
440 |
$6K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
58 |
53 |
$5K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
45 |
41 |
$5K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
136 |
114 |
$5K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
60 |
50 |
$5K |
| A7002 |
Tubing, used with suction pump, each |
518 |
481 |
$5K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
547 |
516 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
81 |
78 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
53 |
52 |
$1K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
94 |
36 |
$751.21 |
| A7015 |
Aerosol mask, used with dme nebulizer |
12 |
12 |
$12.60 |