| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
9,210 |
8,508 |
$296K |
| X1939 |
|
3,639 |
3,612 |
$227K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,010 |
1,965 |
$133K |
| T5999 |
Supply, not otherwise specified |
15,465 |
13,872 |
$126K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,206 |
2,123 |
$118K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,260 |
2,173 |
$103K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,625 |
2,565 |
$77K |
| K0003 |
Lightweight wheelchair |
4,140 |
2,530 |
$65K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
771 |
718 |
$64K |
| E0570 |
Nebulizer, with compressor |
1,356 |
947 |
$43K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
570 |
542 |
$37K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,151 |
907 |
$36K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
831 |
622 |
$30K |
| A4927 |
Gloves, non-sterile, per 100 |
2,426 |
1,628 |
$26K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,127 |
588 |
$20K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
144 |
129 |
$18K |
| K0001 |
Standard wheelchair |
1,310 |
1,112 |
$17K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
61 |
59 |
$8K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
321 |
279 |
$6K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
61 |
52 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
994 |
662 |
$3K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
419 |
338 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
149 |
92 |
$3K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
32 |
31 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
34 |
27 |
$1K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
19 |
12 |
$1K |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
301 |
261 |
$932.89 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
35 |
26 |
$759.44 |
| A7015 |
Aerosol mask, used with dme nebulizer |
351 |
308 |
$469.76 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
69 |
38 |
$452.53 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
30 |
26 |
$313.74 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
16 |
12 |
$258.58 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
30 |
24 |
$242.02 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
15 |
13 |
$201.53 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
13 |
13 |
$19.63 |