| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,037 |
946 |
$112K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,826 |
2,983 |
$93K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
2,415 |
2,131 |
$87K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,165 |
1,051 |
$63K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
154 |
145 |
$19K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,594 |
1,923 |
$18K |
| E0601 |
Continuous positive airway pressure (cpap) device |
466 |
362 |
$12K |
| A4927 |
Gloves, non-sterile, per 100 |
803 |
665 |
$11K |
| K0001 |
Standard wheelchair |
788 |
635 |
$9K |
| E0570 |
Nebulizer, with compressor |
2,072 |
1,640 |
$7K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
63 |
52 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
535 |
360 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
279 |
235 |
$4K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
18 |
12 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,304 |
519 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
288 |
211 |
$430.00 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
72 |
50 |
$280.91 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
38 |
31 |
$232.19 |
| A7035 |
Headgear used with positive airway pressure device |
40 |
25 |
$150.05 |