| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
781 |
600 |
$405K |
| 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 |
845 |
641 |
$47K |
| 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 |
370 |
296 |
$28K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
309 |
268 |
$23K |
| K0001 |
Standard wheelchair |
638 |
591 |
$13K |
| K0003 |
Lightweight wheelchair |
509 |
463 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
265 |
258 |
$4K |
| E0627 |
Seat lift mechanism, electric, any type |
90 |
66 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
102 |
91 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
79 |
74 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
346 |
327 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
28 |
26 |
$607.35 |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
24 |
12 |
$225.33 |