| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,847 |
2,817 |
$459K |
| 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 |
1,088 |
1,075 |
$356K |
| A4554 |
Disposable underpads, all sizes |
7,456 |
7,420 |
$259K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,083 |
1,080 |
$112K |
| B9998 |
Noc for enteral supplies |
1,350 |
1,144 |
$105K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
337 |
333 |
$88K |
| 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 |
291 |
287 |
$83K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
707 |
698 |
$66K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
629 |
625 |
$60K |
| A4335 |
Incontinence supply; miscellaneous |
10,347 |
10,280 |
$58K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
455 |
454 |
$47K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
333 |
326 |
$37K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
191 |
190 |
$29K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
252 |
252 |
$24K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
171 |
171 |
$21K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
544 |
536 |
$13K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
77 |
76 |
$11K |
| K0001 |
Standard wheelchair |
264 |
261 |
$11K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,011 |
1,004 |
$9K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
33 |
12 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
306 |
304 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
274 |
270 |
$4K |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$1K |
| 97542 |
|
34 |
30 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
404 |
378 |
$1K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
26 |
26 |
$688.83 |
| A7000 |
Canister, disposable, used with suction pump, each |
24 |
24 |
$586.97 |
| A7015 |
Aerosol mask, used with dme nebulizer |
370 |
367 |
$481.53 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
258 |
255 |
$421.94 |
| A7002 |
Tubing, used with suction pump, each |
50 |
48 |
$416.59 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
205 |
203 |
$354.49 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
61 |
60 |
$304.67 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$218.82 |
| A4927 |
Gloves, non-sterile, per 100 |
29 |
28 |
$197.12 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
12 |
12 |
$60.38 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
13 |
12 |
$6.86 |