| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,813 |
6,722 |
$693K |
| A4554 |
Disposable underpads, all sizes |
19,747 |
19,531 |
$648K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
14,740 |
14,314 |
$544K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,887 |
2,838 |
$421K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,912 |
3,877 |
$330K |
| A4335 |
Incontinence supply; miscellaneous |
24,652 |
24,322 |
$136K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
517 |
508 |
$55K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,304 |
2,214 |
$10K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
65 |
64 |
$10K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
55 |
52 |
$6K |
| K0003 |
Lightweight wheelchair |
393 |
393 |
$6K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
174 |
173 |
$4K |
| A4670 |
Automatic blood pressure monitor |
53 |
53 |
$3K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
27 |
27 |
$3K |
| A4259 |
Lancets, per box of 100 |
2,261 |
2,202 |
$1K |
| E0570 |
Nebulizer, with compressor |
453 |
451 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
14 |
13 |
$168.27 |
| 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 |
128 |
114 |
$82.72 |
| A7015 |
Aerosol mask, used with dme nebulizer |
14 |
13 |
$12.03 |