| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
10,070 |
9,874 |
$336K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
242 |
238 |
$320K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,001 |
1,940 |
$268K |
| 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 |
858 |
814 |
$243K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
935 |
880 |
$236K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,223 |
2,161 |
$209K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,759 |
1,712 |
$161K |
| B9998 |
Noc for enteral supplies |
2,348 |
1,961 |
$150K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,061 |
1,013 |
$132K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,113 |
1,100 |
$126K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
422 |
405 |
$109K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,129 |
1,098 |
$106K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
562 |
546 |
$90K |
| A4335 |
Incontinence supply; miscellaneous |
11,513 |
11,299 |
$58K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,652 |
1,610 |
$54K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
433 |
415 |
$36K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
281 |
267 |
$35K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
276 |
258 |
$32K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,811 |
1,759 |
$30K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,095 |
1,044 |
$24K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
256 |
247 |
$23K |
| A7002 |
Tubing, used with suction pump, each |
1,103 |
1,057 |
$18K |
| 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 |
64 |
60 |
$17K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
141 |
138 |
$13K |
| K0001 |
Standard wheelchair |
148 |
142 |
$7K |
| A4322 |
Irrigation syringe, bulb or piston, each |
910 |
876 |
$7K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
573 |
553 |
$6K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,003 |
948 |
$5K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
271 |
262 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
381 |
371 |
$698.84 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
40 |
40 |
$474.03 |
| A7526 |
Tracheostomy tube collar/holder, each |
52 |
48 |
$395.41 |
| A4217 |
Sterile water/saline, 500 ml |
12 |
12 |
$281.49 |