| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
14,766 |
13,808 |
$518K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,326 |
5,933 |
$401K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,678 |
2,543 |
$392K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
569 |
522 |
$330K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,418 |
2,286 |
$299K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,614 |
6,285 |
$294K |
| 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 |
700 |
534 |
$291K |
| 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 |
1,673 |
1,418 |
$269K |
| 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 |
1,720 |
1,475 |
$238K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,768 |
4,428 |
$226K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,501 |
1,433 |
$210K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,672 |
2,193 |
$208K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,564 |
1,468 |
$200K |
| A4927 |
Gloves, non-sterile, per 100 |
7,498 |
6,673 |
$131K |
| B9998 |
Noc for enteral supplies |
814 |
305 |
$128K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
11,735 |
6,234 |
$116K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
833 |
792 |
$101K |
| 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 |
694 |
560 |
$74K |
| E1392 |
Portable oxygen concentrator, rental |
1,419 |
1,188 |
$59K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
298 |
237 |
$57K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
320 |
273 |
$54K |
| E0570 |
Nebulizer, with compressor |
1,206 |
1,004 |
$38K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
599 |
414 |
$31K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
1,698 |
923 |
$24K |
| A4335 |
Incontinence supply; miscellaneous |
2,633 |
1,981 |
$22K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
110 |
101 |
$18K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
106 |
102 |
$13K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
647 |
491 |
$9K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
270 |
255 |
$7K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
701 |
418 |
$7K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
230 |
221 |
$7K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
29 |
27 |
$5K |
| A4322 |
Irrigation syringe, bulb or piston, each |
83 |
63 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,189 |
1,115 |
$4K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
33 |
25 |
$3K |
| 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 |
22 |
12 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
44 |
41 |
$2K |
| K0001 |
Standard wheelchair |
220 |
120 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
73 |
64 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
93 |
69 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
91 |
60 |
$647.92 |
| A7002 |
Tubing, used with suction pump, each |
180 |
128 |
$627.94 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
15 |
12 |
$561.96 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
89 |
50 |
$512.25 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
255 |
180 |
$449.68 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
28 |
25 |
$436.62 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
56 |
54 |
$310.96 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$181.94 |