| 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 |
8,458 |
5,473 |
$448K |
| T4541 |
Incontinence product, disposable underpad, large, each |
12,317 |
12,091 |
$425K |
| 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 |
3,332 |
2,978 |
$410K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,711 |
7,588 |
$382K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,485 |
5,391 |
$316K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
7,318 |
7,159 |
$310K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
7,089 |
6,928 |
$309K |
| A4245 |
Alcohol wipes, per box |
26,582 |
26,109 |
$207K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,900 |
2,862 |
$189K |
| A4554 |
Disposable underpads, all sizes |
6,154 |
6,105 |
$177K |
| 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 |
790 |
724 |
$147K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,095 |
2,058 |
$141K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,779 |
1,722 |
$121K |
| K0001 |
Standard wheelchair |
7,422 |
5,305 |
$117K |
| 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 |
854 |
733 |
$101K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,838 |
1,813 |
$96K |
| A4927 |
Gloves, non-sterile, per 100 |
14,064 |
13,746 |
$94K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,004 |
5,160 |
$71K |
| E0570 |
Nebulizer, with compressor |
2,921 |
1,986 |
$59K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,395 |
1,375 |
$58K |
| E1399 |
Durable medical equipment, miscellaneous |
340 |
293 |
$53K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,046 |
1,042 |
$51K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
6,879 |
6,656 |
$49K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
1,547 |
966 |
$39K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
987 |
694 |
$28K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,110 |
1,093 |
$21K |
| A4930 |
Gloves, sterile, per pair |
554 |
538 |
$19K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,343 |
2,231 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,340 |
740 |
$15K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
599 |
380 |
$11K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
618 |
404 |
$11K |
| A4335 |
Incontinence supply; miscellaneous |
1,944 |
1,913 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,436 |
1,146 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
451 |
248 |
$3K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
49 |
49 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
49 |
49 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
425 |
375 |
$824.39 |
| A5120 |
Skin barrier, wipes or swabs, each |
12 |
12 |
$541.42 |
| A7015 |
Aerosol mask, used with dme nebulizer |
355 |
315 |
$284.86 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
140 |
80 |
$98.34 |