| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,937 |
4,248 |
$392K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,548 |
1,462 |
$247K |
| A4927 |
Gloves, non-sterile, per 100 |
5,534 |
5,213 |
$234K |
| A4554 |
Disposable underpads, all sizes |
3,083 |
2,875 |
$184K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
863 |
797 |
$123K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
396 |
356 |
$61K |
| E1392 |
Portable oxygen concentrator, rental |
2,612 |
1,794 |
$46K |
| E0570 |
Nebulizer, with compressor |
1,746 |
1,411 |
$41K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
4,096 |
2,960 |
$39K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,063 |
607 |
$20K |
| K0001 |
Standard wheelchair |
867 |
470 |
$10K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
42 |
38 |
$6K |
| A4259 |
Lancets, per box of 100 |
3,447 |
2,503 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
60 |
46 |
$1K |
| E0607 |
Home blood glucose monitor |
74 |
35 |
$829.15 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
61 |
42 |
$570.22 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
470 |
394 |
$304.14 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
17 |
15 |
$28.37 |
| A4258 |
Spring-powered device for lancet, each |
34 |
18 |
$0.00 |