| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,296 |
1,270 |
$150K |
| A4927 |
Gloves, non-sterile, per 100 |
3,166 |
3,144 |
$99K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,215 |
1,208 |
$89K |
| A7030 |
Full face mask used with positive airway pressure device, each |
924 |
922 |
$75K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,196 |
1,177 |
$46K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
355 |
352 |
$43K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,407 |
1,402 |
$40K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
608 |
602 |
$27K |
| E0601 |
Continuous positive airway pressure (cpap) device |
834 |
831 |
$27K |
| A7031 |
Face mask interface, replacement for full face mask, each |
900 |
888 |
$26K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
306 |
302 |
$25K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
109 |
108 |
$15K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
956 |
954 |
$15K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
369 |
368 |
$15K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
130 |
130 |
$14K |
| A7035 |
Headgear used with positive airway pressure device |
686 |
684 |
$11K |
| 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 |
123 |
122 |
$9K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
260 |
259 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,612 |
1,579 |
$6K |
| K0001 |
Standard wheelchair |
413 |
413 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
49 |
49 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
217 |
217 |
$4K |
| 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 |
38 |
36 |
$4K |
| E0570 |
Nebulizer, with compressor |
24 |
24 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
64 |
64 |
$2K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
667 |
663 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
140 |
140 |
$879.06 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
25 |
25 |
$621.46 |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
24 |
24 |
$368.60 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
70 |
55 |
$165.33 |