| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,797 |
1,714 |
$502K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,869 |
3,805 |
$385K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
7,627 |
4,393 |
$230K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
777 |
298 |
$136K |
| E0430 |
Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,102 |
1,858 |
$123K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,485 |
989 |
$105K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,230 |
817 |
$93K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,262 |
1,769 |
$87K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,701 |
766 |
$75K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,538 |
946 |
$69K |
| 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 |
369 |
183 |
$68K |
| 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 |
553 |
268 |
$67K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
932 |
472 |
$53K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
646 |
425 |
$50K |
| A4554 |
Disposable underpads, all sizes |
3,138 |
2,255 |
$45K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
698 |
301 |
$36K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
250 |
142 |
$31K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
1,234 |
416 |
$29K |
| B9002 |
Enteral nutrition infusion pump, any type |
898 |
464 |
$21K |
| E0570 |
Nebulizer, with compressor |
559 |
455 |
$18K |
| A4927 |
Gloves, non-sterile, per 100 |
2,230 |
1,194 |
$18K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,683 |
1,319 |
$17K |
| B9998 |
Noc for enteral supplies |
803 |
454 |
$15K |
| 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 |
144 |
98 |
$12K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
241 |
99 |
$10K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
182 |
149 |
$9K |
| A4259 |
Lancets, per box of 100 |
893 |
607 |
$9K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
117 |
62 |
$8K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
96 |
63 |
$7K |
| B4100 |
Food thickener, administered orally, per ounce |
197 |
134 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
142 |
85 |
$5K |
| K0001 |
Standard wheelchair |
687 |
534 |
$5K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
122 |
96 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
45 |
38 |
$3K |
| E1070 |
Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest |
65 |
28 |
$2K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
68 |
54 |
$2K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
14 |
12 |
$1K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
326 |
205 |
$1K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
17 |
12 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
24 |
13 |
$835.12 |
| A4322 |
Irrigation syringe, bulb or piston, each |
84 |
61 |
$750.08 |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
62 |
25 |
$688.40 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
89 |
73 |
$186.30 |
| A7035 |
Headgear used with positive airway pressure device |
51 |
39 |
$72.84 |
| T4541 |
Incontinence product, disposable underpad, large, each |
21 |
13 |
$0.00 |