| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,338 |
1,149 |
$47K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
210 |
160 |
$18K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
207 |
78 |
$8K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
940 |
713 |
$8K |
| E0570 |
Nebulizer, with compressor |
647 |
617 |
$8K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
492 |
427 |
$7K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
51 |
43 |
$5K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
218 |
216 |
$5K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
127 |
41 |
$4K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
38 |
26 |
$2K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
73 |
30 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
310 |
135 |
$2K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
12 |
12 |
$1K |
| K0001 |
Standard wheelchair |
154 |
154 |
$933.83 |
| E1392 |
Portable oxygen concentrator, rental |
209 |
208 |
$922.69 |
| E0601 |
Continuous positive airway pressure (cpap) device |
51 |
36 |
$805.30 |
| A4259 |
Lancets, per box of 100 |
167 |
145 |
$453.59 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
103 |
69 |
$320.91 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
247 |
144 |
$233.56 |
| B9998 |
Noc for enteral supplies |
21 |
12 |
$158.15 |
| A7015 |
Aerosol mask, used with dme nebulizer |
110 |
94 |
$82.10 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
121 |
64 |
$38.17 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
26 |
14 |
$28.80 |