| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,008 |
1,821 |
$240K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,045 |
841 |
$115K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
949 |
832 |
$111K |
| A4927 |
Gloves, non-sterile, per 100 |
4,410 |
4,064 |
$97K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
577 |
491 |
$41K |
| E0570 |
Nebulizer, with compressor |
1,108 |
1,033 |
$39K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
991 |
894 |
$37K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
883 |
814 |
$20K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
817 |
741 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
142 |
130 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
180 |
177 |
$3K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
142 |
137 |
$2K |
| K0001 |
Standard wheelchair |
526 |
486 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
15 |
12 |
$889.92 |
| A4259 |
Lancets, per box of 100 |
291 |
260 |
$869.71 |
| A7000 |
Canister, disposable, used with suction pump, each |
12 |
12 |
$248.40 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
15 |
12 |
$139.68 |
| A5120 |
Skin barrier, wipes or swabs, each |
13 |
12 |
$95.45 |
| A7015 |
Aerosol mask, used with dme nebulizer |
31 |
31 |
$40.61 |
| A7002 |
Tubing, used with suction pump, each |
14 |
14 |
$26.10 |