| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5199 |
Personal care item, nos, each |
1,969 |
1,863 |
$162K |
| A4554 |
Disposable underpads, all sizes |
1,911 |
1,861 |
$91K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
612 |
582 |
$75K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
520 |
506 |
$58K |
| 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 |
1,087 |
657 |
$56K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,664 |
3,239 |
$20K |
| A4927 |
Gloves, non-sterile, per 100 |
1,704 |
1,456 |
$19K |
| E0601 |
Continuous positive airway pressure (cpap) device |
741 |
570 |
$19K |
| K0001 |
Standard wheelchair |
5,287 |
3,495 |
$16K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
722 |
409 |
$12K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,300 |
1,694 |
$10K |
| K0003 |
Lightweight wheelchair |
1,495 |
997 |
$7K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
972 |
641 |
$6K |
| E0570 |
Nebulizer, with compressor |
2,176 |
1,298 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
646 |
450 |
$4K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
155 |
103 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
311 |
223 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
424 |
355 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,240 |
844 |
$1K |
| A4259 |
Lancets, per box of 100 |
2,142 |
1,579 |
$1K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,779 |
1,313 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
292 |
188 |
$317.54 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
63 |
41 |
$202.31 |
| A4256 |
Normal, low and high calibrator solution / chips |
372 |
256 |
$135.38 |
| E0277 |
Powered pressure-reducing air mattress |
32 |
24 |
$69.10 |
| E0156 |
Seat attachment, walker |
176 |
130 |
$60.80 |
| A7015 |
Aerosol mask, used with dme nebulizer |
180 |
113 |
$48.16 |
| A4258 |
Spring-powered device for lancet, each |
60 |
36 |
$24.58 |