| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Continuous positive airway pressure (cpap) device |
1,282 |
1,279 |
$72K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
528 |
528 |
$47K |
| 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 |
171 |
157 |
$32K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
566 |
566 |
$27K |
| K0001 |
Standard wheelchair |
800 |
800 |
$26K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
630 |
629 |
$25K |
| E0570 |
Nebulizer, with compressor |
281 |
280 |
$23K |
| 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) |
135 |
135 |
$16K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,511 |
1,508 |
$8K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,524 |
1,523 |
$8K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
852 |
834 |
$7K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
271 |
269 |
$7K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
181 |
178 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
82 |
82 |
$5K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
321 |
321 |
$3K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
97 |
97 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
37 |
37 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
56 |
55 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
13 |
12 |
$817.49 |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
37 |
37 |
$756.36 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
24 |
24 |
$204.88 |
| A4322 |
Irrigation syringe, bulb or piston, each |
13 |
12 |
$117.15 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
15 |
15 |
$0.00 |