| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
527 |
514 |
$55K |
| 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 |
581 |
562 |
$55K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,367 |
1,348 |
$54K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
538 |
522 |
$40K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
762 |
734 |
$37K |
| 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 |
296 |
286 |
$29K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
495 |
471 |
$26K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
178 |
176 |
$17K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
209 |
203 |
$6K |
| E0601 |
Continuous positive airway pressure (cpap) device |
62 |
62 |
$3K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
104 |
99 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
76 |
73 |
$1K |
| K0001 |
Standard wheelchair |
38 |
37 |
$495.67 |