| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,813 |
6,788 |
$815K |
| A4554 |
Disposable underpads, all sizes |
18,013 |
17,966 |
$647K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,318 |
5,301 |
$551K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
14,382 |
13,610 |
$502K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,475 |
2,381 |
$337K |
| A4335 |
Incontinence supply; miscellaneous |
21,464 |
21,364 |
$120K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
162 |
160 |
$91K |
| E0570 |
Nebulizer, with compressor |
140 |
137 |
$16K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
656 |
655 |
$11K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
99 |
99 |
$8K |
| A4245 |
Alcohol wipes, per box |
3,479 |
3,474 |
$7K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
12 |
12 |
$2K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
176 |
173 |
$1K |
| A4670 |
Automatic blood pressure monitor |
15 |
15 |
$934.50 |
| A4259 |
Lancets, per box of 100 |
424 |
423 |
$915.80 |
| 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 |
467 |
323 |
$556.44 |
| 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 |
479 |
322 |
$321.17 |
| A7015 |
Aerosol mask, used with dme nebulizer |
164 |
161 |
$224.64 |
| E1399 |
Durable medical equipment, miscellaneous |
20 |
13 |
$210.08 |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
18 |
12 |
$0.00 |