| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
26,201 |
26,024 |
$1.08M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13,024 |
12,961 |
$1.07M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
14,324 |
14,241 |
$990K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,549 |
2,512 |
$822K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
10,447 |
10,397 |
$792K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
8,313 |
8,284 |
$726K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,731 |
5,518 |
$482K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
6,308 |
6,274 |
$473K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
15,392 |
15,297 |
$437K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
14,418 |
14,348 |
$358K |
| E1392 |
Portable oxygen concentrator, rental |
5,154 |
5,147 |
$349K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,020 |
2,017 |
$279K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,090 |
3,072 |
$227K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,870 |
4,863 |
$218K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,219 |
2,218 |
$210K |
| 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) |
1,365 |
1,364 |
$183K |
| E0570 |
Nebulizer, with compressor |
5,293 |
5,284 |
$173K |
| 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 |
1,956 |
1,936 |
$142K |
| 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 |
1,685 |
1,663 |
$122K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,149 |
1,146 |
$105K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,706 |
4,699 |
$92K |
| A4927 |
Gloves, non-sterile, per 100 |
22,800 |
22,641 |
$84K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,233 |
4,230 |
$69K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,399 |
1,355 |
$58K |
| 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 |
389 |
389 |
$54K |
| K0001 |
Standard wheelchair |
2,138 |
2,133 |
$47K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
872 |
872 |
$43K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
242 |
241 |
$36K |
| A7037 |
Tubing used with positive airway pressure device |
2,880 |
2,876 |
$25K |
| A7035 |
Headgear used with positive airway pressure device |
1,840 |
1,836 |
$23K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
426 |
412 |
$22K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,286 |
1,271 |
$22K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
615 |
606 |
$19K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,542 |
1,532 |
$17K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
416 |
414 |
$13K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,089 |
1,065 |
$11K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
96 |
96 |
$11K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
309 |
177 |
$10K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
894 |
890 |
$10K |
| A4670 |
Automatic blood pressure monitor |
194 |
192 |
$8K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
230 |
228 |
$8K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
710 |
708 |
$8K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,130 |
3,106 |
$7K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
417 |
408 |
$5K |
| A7000 |
Canister, disposable, used with suction pump, each |
722 |
712 |
$5K |
| B9999 |
Noc for parenteral supplies |
190 |
190 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,162 |
2,130 |
$4K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
49 |
40 |
$4K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
70 |
67 |
$4K |
| E0776 |
Iv pole |
2,033 |
2,029 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
578 |
574 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
200 |
199 |
$2K |
| 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 |
12 |
12 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
53 |
53 |
$2K |
| E0156 |
Seat attachment, walker |
144 |
144 |
$2K |
| E1399 |
Durable medical equipment, miscellaneous |
12 |
12 |
$2K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
199 |
198 |
$1K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
394 |
384 |
$1K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
381 |
381 |
$1K |
| A7002 |
Tubing, used with suction pump, each |
938 |
705 |
$1K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
17 |
16 |
$865.74 |
| B4100 |
Food thickener, administered orally, per ounce |
24 |
24 |
$709.32 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
14 |
14 |
$570.07 |
| A5120 |
Skin barrier, wipes or swabs, each |
37 |
37 |
$297.81 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
12 |
12 |
$230.47 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
12 |
12 |
$126.21 |