| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
6,587 |
6,155 |
$355K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,965 |
1,851 |
$272K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,853 |
1,772 |
$253K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,060 |
988 |
$132K |
| E0570 |
Nebulizer, with compressor |
2,049 |
1,536 |
$113K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,416 |
2,342 |
$97K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,250 |
864 |
$60K |
| A4927 |
Gloves, non-sterile, per 100 |
2,295 |
2,137 |
$45K |
| 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 |
349 |
341 |
$31K |
| A7037 |
Tubing used with positive airway pressure device |
2,084 |
1,415 |
$20K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
846 |
720 |
$17K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
173 |
155 |
$7K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
61 |
37 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
572 |
424 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,566 |
1,740 |
$6K |
| A4335 |
Incontinence supply; miscellaneous |
591 |
561 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
260 |
165 |
$4K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
19 |
12 |
$3K |
| K0001 |
Standard wheelchair |
373 |
246 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
783 |
676 |
$1K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
74 |
48 |
$1K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
18 |
12 |
$674.54 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
56 |
25 |
$607.13 |