| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,499 |
1,357 |
$303K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,946 |
3,459 |
$297K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,727 |
5,819 |
$278K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,132 |
2,780 |
$257K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,366 |
2,999 |
$219K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,384 |
5,914 |
$207K |
| 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 |
2,138 |
1,884 |
$187K |
| A4927 |
Gloves, non-sterile, per 100 |
4,845 |
4,532 |
$72K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,364 |
2,233 |
$61K |
| 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 |
427 |
371 |
$52K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,432 |
1,367 |
$41K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,434 |
1,385 |
$40K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
306 |
299 |
$30K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,314 |
1,259 |
$22K |
| K0001 |
Standard wheelchair |
623 |
598 |
$12K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,020 |
954 |
$11K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
64 |
55 |
$6K |
| A7037 |
Tubing used with positive airway pressure device |
827 |
763 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
411 |
388 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,557 |
2,277 |
$4K |
| 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 |
28 |
24 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
76 |
69 |
$3K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
27 |
24 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
13 |
12 |
$206.46 |
| A9270 |
Non-covered item or service |
14 |
13 |
$0.00 |