| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
11,312 |
11,294 |
$841K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,906 |
4,895 |
$588K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,988 |
3,970 |
$579K |
| 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 |
2,564 |
2,553 |
$436K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,597 |
2,591 |
$380K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,203 |
1,198 |
$270K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,715 |
2,712 |
$239K |
| 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 |
1,506 |
1,495 |
$238K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,349 |
1,349 |
$220K |
| 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 |
1,114 |
1,112 |
$208K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,566 |
4,563 |
$156K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
156 |
154 |
$134K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
921 |
916 |
$110K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
759 |
758 |
$104K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
920 |
918 |
$99K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,135 |
3,123 |
$55K |
| A4927 |
Gloves, non-sterile, per 100 |
10,009 |
9,997 |
$44K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
296 |
295 |
$44K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
347 |
345 |
$42K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,910 |
1,909 |
$37K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,208 |
2,202 |
$24K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,494 |
1,492 |
$23K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,174 |
1,174 |
$22K |
| 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 |
111 |
107 |
$21K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
844 |
836 |
$20K |
| A4217 |
Sterile water/saline, 500 ml |
1,281 |
1,278 |
$16K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,607 |
1,602 |
$10K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
961 |
958 |
$8K |
| A7002 |
Tubing, used with suction pump, each |
1,721 |
1,715 |
$8K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
698 |
695 |
$3K |
| A7526 |
Tracheostomy tube collar/holder, each |
37 |
37 |
$3K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
36 |
36 |
$1K |