| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
18,168 |
17,250 |
$701K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
9,778 |
9,099 |
$619K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
6,628 |
6,283 |
$505K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,629 |
2,524 |
$485K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
9,647 |
7,660 |
$357K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
6,380 |
5,916 |
$333K |
| T4541 |
Incontinence product, disposable underpad, large, each |
10,239 |
9,731 |
$215K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,204 |
2,652 |
$110K |
| A4927 |
Gloves, non-sterile, per 100 |
7,835 |
7,331 |
$99K |
| 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 |
567 |
504 |
$84K |
| 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 |
1,022 |
897 |
$81K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
967 |
961 |
$73K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,557 |
4,320 |
$64K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,517 |
2,042 |
$60K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,092 |
1,023 |
$54K |
| E0570 |
Nebulizer, with compressor |
3,781 |
2,802 |
$48K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
488 |
429 |
$37K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,106 |
959 |
$31K |
| K0001 |
Standard wheelchair |
1,854 |
1,631 |
$22K |
| A7030 |
Full face mask used with positive airway pressure device, each |
363 |
294 |
$19K |
| A7035 |
Headgear used with positive airway pressure device |
1,000 |
810 |
$14K |
| B9998 |
Noc for enteral supplies |
221 |
140 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
769 |
620 |
$10K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
151 |
141 |
$9K |
| A7031 |
Face mask interface, replacement for full face mask, each |
324 |
242 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,446 |
2,016 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
465 |
351 |
$5K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
72 |
62 |
$4K |
| E1392 |
Portable oxygen concentrator, rental |
242 |
170 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
224 |
190 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
148 |
136 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13 |
12 |
$784.32 |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
14 |
13 |
$532.30 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
380 |
324 |
$493.46 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
88 |
68 |
$465.00 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
144 |
101 |
$374.27 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
475 |
376 |
$174.92 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
137 |
119 |
$27.36 |
| A7015 |
Aerosol mask, used with dme nebulizer |
29 |
25 |
$20.33 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
70 |
66 |
$0.00 |