| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,506 |
6,237 |
$609K |
| 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 |
5,978 |
5,668 |
$581K |
| A4554 |
Disposable underpads, all sizes |
14,987 |
14,476 |
$539K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
4,243 |
4,060 |
$533K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,061 |
4,110 |
$351K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
11,973 |
11,552 |
$338K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,596 |
3,483 |
$318K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,606 |
3,471 |
$269K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,942 |
6,704 |
$218K |
| E0570 |
Nebulizer, with compressor |
3,416 |
2,559 |
$179K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,159 |
1,119 |
$158K |
| A4927 |
Gloves, non-sterile, per 100 |
8,590 |
8,390 |
$149K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,551 |
1,206 |
$67K |
| S5165 |
Home modifications; per service |
79 |
64 |
$60K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
677 |
643 |
$47K |
| T2025 |
Waiver services; not otherwise specified (nos) |
1,802 |
1,660 |
$31K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,391 |
1,885 |
$27K |
| K0001 |
Standard wheelchair |
2,261 |
1,421 |
$17K |
| A4335 |
Incontinence supply; miscellaneous |
1,798 |
1,740 |
$14K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
489 |
425 |
$11K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
191 |
158 |
$8K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
398 |
280 |
$7K |
| E1392 |
Portable oxygen concentrator, rental |
433 |
353 |
$6K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
198 |
158 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
3,026 |
1,538 |
$5K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
41 |
37 |
$3K |
| K0003 |
Lightweight wheelchair |
91 |
66 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,268 |
1,005 |
$2K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
17 |
12 |
$2K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
17 |
12 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
207 |
119 |
$1K |
| A4259 |
Lancets, per box of 100 |
1,513 |
879 |
$232.33 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
44 |
36 |
$105.55 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
100 |
52 |
$66.68 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
17 |
12 |
$52.80 |