| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,887 |
2,857 |
$106K |
| A4554 |
Disposable underpads, all sizes |
2,128 |
2,092 |
$94K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
769 |
763 |
$57K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,076 |
1,060 |
$31K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
423 |
250 |
$29K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
216 |
211 |
$14K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
197 |
193 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
1,093 |
1,084 |
$5K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
25 |
25 |
$4K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
47 |
27 |
$2K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
54 |
54 |
$2K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
25 |
25 |
$2K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
22 |
14 |
$1K |
| E0570 |
Nebulizer, with compressor |
79 |
79 |
$395.62 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
50 |
49 |
$255.23 |
| A4670 |
Automatic blood pressure monitor |
12 |
12 |
$170.30 |
| A4259 |
Lancets, per box of 100 |
12 |
12 |
$16.74 |