| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
2,348 |
2,265 |
$1.27M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,003 |
3,971 |
$518K |
| A4554 |
Disposable underpads, all sizes |
10,196 |
10,098 |
$364K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,263 |
2,189 |
$333K |
| 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 |
669 |
655 |
$274K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,085 |
1,063 |
$270K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,115 |
2,107 |
$252K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,731 |
4,662 |
$232K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
500 |
484 |
$132K |
| 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 |
655 |
639 |
$116K |
| 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 |
594 |
584 |
$86K |
| A4335 |
Incontinence supply; miscellaneous |
13,479 |
13,309 |
$72K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
344 |
344 |
$27K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
406 |
406 |
$13K |
| A4670 |
Automatic blood pressure monitor |
224 |
218 |
$12K |
| K0001 |
Standard wheelchair |
103 |
101 |
$8K |
| E0570 |
Nebulizer, with compressor |
243 |
243 |
$6K |
| E0627 |
Seat lift mechanism, electric, any type |
32 |
32 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
66 |
65 |
$2K |
| E0156 |
Seat attachment, walker |
95 |
93 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
24 |
24 |
$143.12 |