| 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 |
98 |
92 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
294 |
258 |
$3K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
27 |
25 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
103 |
93 |
$1K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
20 |
13 |
$447.32 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
18 |
13 |
$419.21 |