| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,159 |
1,606 |
$1.39M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,355 |
2,096 |
$137K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,135 |
1,995 |
$85K |
| 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 |
739 |
678 |
$76K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,929 |
1,816 |
$74K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
290 |
278 |
$42K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
331 |
294 |
$39K |
| K0001 |
Standard wheelchair |
1,439 |
1,311 |
$32K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
902 |
815 |
$26K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
253 |
213 |
$25K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
384 |
353 |
$22K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
211 |
176 |
$21K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
702 |
584 |
$15K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
271 |
256 |
$14K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
44 |
38 |
$11K |
| A4927 |
Gloves, non-sterile, per 100 |
542 |
506 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,142 |
2,987 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
198 |
189 |
$4K |
| A7030 |
Full face mask used with positive airway pressure device, each |
25 |
25 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
31 |
27 |
$1K |
| E0570 |
Nebulizer, with compressor |
25 |
25 |
$997.42 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
105 |
101 |
$782.85 |
| A7031 |
Face mask interface, replacement for full face mask, each |
26 |
26 |
$735.38 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
151 |
138 |
$417.40 |
| E0245 |
Tub stool or bench |
14 |
14 |
$369.00 |
| A7037 |
Tubing used with positive airway pressure device |
12 |
12 |
$216.09 |
| E0156 |
Seat attachment, walker |
13 |
12 |
$123.00 |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
15 |
13 |
$0.00 |