| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,800 |
5,768 |
$682K |
| A4554 |
Disposable underpads, all sizes |
17,087 |
17,010 |
$609K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,671 |
9,468 |
$386K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,509 |
3,492 |
$368K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,542 |
1,534 |
$228K |
| A4335 |
Incontinence supply; miscellaneous |
19,429 |
19,317 |
$105K |
| E0570 |
Nebulizer, with compressor |
1,443 |
1,437 |
$72K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
222 |
222 |
$21K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
838 |
837 |
$19K |
| K0001 |
Standard wheelchair |
1,590 |
1,576 |
$18K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
128 |
128 |
$17K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,975 |
1,948 |
$10K |
| K0004 |
High strength, lightweight wheelchair |
206 |
206 |
$6K |
| A4670 |
Automatic blood pressure monitor |
89 |
89 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
26 |
26 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
262 |
262 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
112 |
112 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
419 |
417 |
$701.35 |
| A7015 |
Aerosol mask, used with dme nebulizer |
404 |
398 |
$448.33 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$378.81 |
| 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 |
275 |
170 |
$269.10 |
| A4259 |
Lancets, per box of 100 |
260 |
260 |
$186.50 |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
273 |
167 |
$77.40 |
| 0012A |
|
113 |
113 |
$0.00 |
| 0011A |
|
123 |
123 |
$0.00 |