| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B9998 |
Noc for enteral supplies |
25,858 |
14,000 |
$7.71M |
| E1399 |
Durable medical equipment, miscellaneous |
1,573 |
924 |
$6.42M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14,678 |
12,978 |
$4.46M |
| 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 |
6,921 |
6,003 |
$4.37M |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
12,698 |
6,478 |
$4.02M |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
6,964 |
5,734 |
$3.02M |
| B9002 |
Enteral nutrition infusion pump, any type |
14,390 |
12,031 |
$1.39M |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
8,566 |
7,364 |
$1.31M |
| 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 |
1,356 |
1,202 |
$948K |
| S8189 |
Tracheostomy supply, not otherwise classified |
1,383 |
721 |
$836K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
7,182 |
7,033 |
$798K |
| A4554 |
Disposable underpads, all sizes |
20,301 |
19,447 |
$738K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
6,156 |
5,998 |
$717K |
| T5999 |
Supply, not otherwise specified |
39,772 |
36,366 |
$671K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
4,671 |
3,906 |
$641K |
| 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 |
3,061 |
2,661 |
$490K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,838 |
3,739 |
$482K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,284 |
3,769 |
$459K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,384 |
2,091 |
$432K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
13,199 |
3,528 |
$343K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,682 |
2,435 |
$314K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,437 |
3,794 |
$304K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
12,449 |
11,108 |
$303K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
7,648 |
7,065 |
$281K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,405 |
1,170 |
$197K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,196 |
2,155 |
$194K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
187 |
178 |
$178K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,236 |
945 |
$173K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
719 |
652 |
$168K |
| A4452 |
Tape, waterproof, per 18 square inches |
6,228 |
5,472 |
$150K |
| E0641 |
Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels |
25 |
12 |
$144K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
624 |
308 |
$140K |
| 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 |
554 |
492 |
$129K |
| 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 |
327 |
307 |
$128K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,953 |
1,705 |
$124K |
| A4927 |
Gloves, non-sterile, per 100 |
11,379 |
8,911 |
$120K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,354 |
1,281 |
$107K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,604 |
1,543 |
$104K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
2,432 |
2,115 |
$97K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
46 |
28 |
$85K |
| A4322 |
Irrigation syringe, bulb or piston, each |
5,809 |
5,081 |
$85K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
5,209 |
4,589 |
$83K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,043 |
959 |
$80K |
| X1915 |
|
389 |
353 |
$78K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,515 |
830 |
$69K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
488 |
413 |
$63K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
589 |
578 |
$60K |
| E0700 |
Safety equipment, device or accessory, any type |
258 |
225 |
$46K |
| T5001 |
Positioning seat for persons with special orthopedic needs |
42 |
38 |
$37K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
235 |
156 |
$36K |
| A7002 |
Tubing, used with suction pump, each |
5,492 |
4,620 |
$31K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
15 |
13 |
$29K |
| K0040 |
Adjustable angle footplate, each |
277 |
244 |
$26K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
143 |
139 |
$23K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
147 |
133 |
$22K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
134 |
126 |
$21K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,780 |
1,048 |
$16K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
185 |
97 |
$15K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
248 |
222 |
$15K |
| A4217 |
Sterile water/saline, 500 ml |
1,007 |
816 |
$15K |
| E0950 |
Wheelchair accessory, tray, each |
222 |
191 |
$14K |
| A4553 |
Non-disposable underpads, all sizes |
396 |
379 |
$14K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
125 |
113 |
$12K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
209 |
188 |
$11K |
| A4208 |
Syringe with needle, sterile 3 cc, each |
1,604 |
1,494 |
$10K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
59 |
45 |
$10K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
56 |
48 |
$9K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
1,443 |
1,342 |
$8K |
| A4459 |
Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type |
69 |
43 |
$7K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
7,200 |
2,774 |
$6K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
272 |
245 |
$6K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
13 |
12 |
$4K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
28 |
28 |
$4K |
| K0070 |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
12 |
12 |
$3K |
| A7001 |
Canister, non-disposable, used with suction pump, each |
77 |
57 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
120 |
97 |
$3K |
| A7526 |
Tracheostomy tube collar/holder, each |
45 |
39 |
$2K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
18 |
18 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
293 |
213 |
$2K |
| E0952 |
Toe loop/holder, any type, each |
79 |
72 |
$2K |
| E0776 |
Iv pole |
17 |
12 |
$2K |
| E0957 |
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each |
21 |
20 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,322 |
220 |
$2K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
41 |
16 |
$884.64 |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
12 |
12 |
$793.44 |
| A4332 |
Lubricant, individual sterile packet, each |
51 |
49 |
$719.02 |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
18 |
15 |
$656.00 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
19 |
15 |
$651.00 |
| A5120 |
Skin barrier, wipes or swabs, each |
43 |
39 |
$414.27 |