| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
65,797 |
59,801 |
$3.44M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
22,344 |
20,613 |
$2.54M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
16,856 |
15,335 |
$1.77M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
15,112 |
13,977 |
$1.60M |
| 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 |
18,204 |
16,241 |
$1.56M |
| A4927 |
Gloves, non-sterile, per 100 |
50,242 |
45,246 |
$1.43M |
| 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 |
10,560 |
9,477 |
$1.21M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
5,776 |
5,417 |
$866K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
5,364 |
4,825 |
$588K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,317 |
4,531 |
$549K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,858 |
3,440 |
$444K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,510 |
2,317 |
$430K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,923 |
3,431 |
$399K |
| 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 |
3,263 |
2,357 |
$346K |
| 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 |
3,205 |
2,627 |
$336K |
| S5165 |
Home modifications; per service |
882 |
678 |
$314K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,721 |
4,451 |
$295K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,219 |
1,948 |
$270K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
8,725 |
5,331 |
$266K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,966 |
5,448 |
$224K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,463 |
756 |
$167K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,389 |
874 |
$139K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,028 |
2,170 |
$121K |
| T2025 |
Waiver services; not otherwise specified (nos) |
2,763 |
2,324 |
$108K |
| K0001 |
Standard wheelchair |
8,904 |
5,336 |
$96K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
888 |
730 |
$96K |
| E0570 |
Nebulizer, with compressor |
7,204 |
4,281 |
$82K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,191 |
1,302 |
$69K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,243 |
4,087 |
$44K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,420 |
938 |
$36K |
| A7030 |
Full face mask used with positive airway pressure device, each |
557 |
356 |
$31K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
372 |
295 |
$28K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
586 |
272 |
$27K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
312 |
280 |
$18K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
266 |
165 |
$16K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
2,548 |
1,715 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
1,004 |
684 |
$13K |
| A4928 |
Surgical mask, per 20 |
662 |
623 |
$12K |
| B9998 |
Noc for enteral supplies |
728 |
552 |
$10K |
| A7035 |
Headgear used with positive airway pressure device |
753 |
531 |
$10K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,710 |
954 |
$10K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
267 |
158 |
$6K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
171 |
75 |
$4K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,483 |
1,738 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,700 |
1,826 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
196 |
111 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,271 |
846 |
$3K |
| E0156 |
Seat attachment, walker |
634 |
360 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
796 |
475 |
$3K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
36 |
24 |
$3K |
| A4670 |
Automatic blood pressure monitor |
43 |
41 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
574 |
334 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
543 |
290 |
$1K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
160 |
86 |
$988.68 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
19 |
12 |
$888.50 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
183 |
126 |
$842.26 |
| A7000 |
Canister, disposable, used with suction pump, each |
71 |
49 |
$709.67 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
1,636 |
1,121 |
$556.38 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
69 |
49 |
$472.70 |
| A4259 |
Lancets, per box of 100 |
602 |
356 |
$137.83 |
| X9999 |
|
23 |
22 |
$0.00 |