| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,171 |
2,046 |
$148K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
393 |
366 |
$87K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
1,034 |
972 |
$84K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
108 |
105 |
$74K |
| E1392 |
Portable oxygen concentrator, rental |
1,020 |
960 |
$35K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
108 |
102 |
$31K |
| L0635 |
Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment |
177 |
176 |
$30K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,498 |
1,378 |
$30K |
| A4554 |
Disposable underpads, all sizes |
459 |
431 |
$27K |
| E0217 |
Water circulating heat pad with pump |
64 |
55 |
$25K |
| A4215 |
Needle, sterile, any size, each |
903 |
817 |
$23K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,124 |
1,047 |
$19K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
53 |
47 |
$12K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
143 |
131 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
426 |
408 |
$8K |
| E0570 |
Nebulizer, with compressor |
169 |
161 |
$8K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
30 |
28 |
$7K |
| A4259 |
Lancets, per box of 100 |
1,206 |
1,107 |
$6K |
| A5120 |
Skin barrier, wipes or swabs, each |
499 |
469 |
$3K |
| L1836 |
Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf |
28 |
24 |
$3K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
493 |
465 |
$2K |
| A4670 |
Automatic blood pressure monitor |
16 |
12 |
$765.78 |