| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
6,794 |
6,052 |
$295K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,717 |
2,379 |
$239K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,551 |
2,274 |
$225K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,251 |
2,034 |
$207K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,493 |
3,012 |
$204K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,783 |
1,500 |
$152K |
| A4927 |
Gloves, non-sterile, per 100 |
7,506 |
6,677 |
$142K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
970 |
853 |
$39K |
| A4259 |
Lancets, per box of 100 |
1,594 |
1,345 |
$33K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
302 |
251 |
$22K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
120 |
104 |
$9K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
457 |
418 |
$7K |
| K0001 |
Standard wheelchair |
870 |
803 |
$6K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
45 |
27 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
43 |
39 |
$2K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
55 |
54 |
$2K |
| E0601 |
Continuous positive airway pressure (cpap) device |
48 |
41 |
$2K |
| E0570 |
Nebulizer, with compressor |
35 |
31 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
41 |
37 |
$1K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
27 |
13 |
$567.85 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
152 |
145 |
$433.89 |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
28 |
13 |
$145.32 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
37 |
36 |
$91.33 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
12 |
12 |
$6.16 |