| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
627 |
512 |
$151K |
| A4927 |
Gloves, non-sterile, per 100 |
1,061 |
835 |
$108K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,109 |
899 |
$64K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
975 |
770 |
$41K |
| A4246 |
Betadine or phisohex solution, per pint |
769 |
643 |
$38K |
| A4245 |
Alcohol wipes, per box |
1,851 |
954 |
$38K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
193 |
163 |
$28K |
| A7030 |
Full face mask used with positive airway pressure device, each |
369 |
300 |
$19K |
| E0601 |
Continuous positive airway pressure (cpap) device |
599 |
583 |
$19K |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
182 |
147 |
$17K |
| A4500 |
Surgical stockings below knee length, each |
75 |
67 |
$14K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
295 |
234 |
$13K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
137 |
114 |
$11K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
196 |
165 |
$10K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
181 |
147 |
$8K |
| A6260 |
Wound cleansers, any type, any size |
214 |
192 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
363 |
287 |
$6K |
| 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) |
69 |
69 |
$6K |
| A4463 |
Surgical dressing holder, reusable, each |
152 |
132 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
394 |
318 |
$4K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
57 |
48 |
$4K |
| A7036 |
Chinstrap used with positive airway pressure device |
295 |
220 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
292 |
217 |
$617.54 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
86 |
82 |
$438.74 |
| A4259 |
Lancets, per box of 100 |
179 |
145 |
$191.82 |
| A7031 |
Face mask interface, replacement for full face mask, each |
18 |
18 |
$126.22 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
18 |
18 |
$52.99 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
39 |
39 |
$0.00 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
17 |
17 |
$0.00 |