| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
982 |
924 |
$95K |
| E0601 |
Continuous positive airway pressure (cpap) device |
710 |
708 |
$36K |
| 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 |
376 |
283 |
$28K |
| T4541 |
Incontinence product, disposable underpad, large, each |
899 |
886 |
$21K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
143 |
135 |
$15K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
339 |
329 |
$11K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
934 |
886 |
$10K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
98 |
98 |
$6K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
148 |
148 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
404 |
368 |
$6K |
| E0570 |
Nebulizer, with compressor |
809 |
803 |
$6K |
| A7030 |
Full face mask used with positive airway pressure device, each |
39 |
39 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
526 |
526 |
$3K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
12 |
12 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
27 |
26 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
164 |
163 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
14 |
14 |
$378.85 |
| A4259 |
Lancets, per box of 100 |
114 |
106 |
$89.36 |