| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,921 |
1,779 |
$381K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,131 |
2,911 |
$343K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,920 |
1,814 |
$337K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,727 |
1,600 |
$257K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,349 |
1,155 |
$255K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,891 |
6,241 |
$238K |
| S9999 |
Sales tax |
14,648 |
12,866 |
$134K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,850 |
1,798 |
$133K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,379 |
3,278 |
$127K |
| A4927 |
Gloves, non-sterile, per 100 |
3,502 |
3,376 |
$99K |
| E0570 |
Nebulizer, with compressor |
4,347 |
4,094 |
$99K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,818 |
2,684 |
$97K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,517 |
1,469 |
$90K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,538 |
2,465 |
$86K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,860 |
2,800 |
$82K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,173 |
1,097 |
$66K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,005 |
990 |
$57K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,176 |
1,145 |
$44K |
| K0001 |
Standard wheelchair |
1,958 |
1,865 |
$28K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
691 |
675 |
$27K |
| A7035 |
Headgear used with positive airway pressure device |
1,938 |
1,878 |
$27K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,266 |
3,002 |
$22K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,641 |
4,500 |
$21K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,610 |
1,580 |
$21K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
161 |
153 |
$19K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
108 |
97 |
$15K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
37 |
26 |
$14K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
82 |
77 |
$14K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,724 |
3,537 |
$10K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
491 |
451 |
$10K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
978 |
964 |
$9K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
153 |
139 |
$8K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
265 |
261 |
$8K |
| A4452 |
Tape, waterproof, per 18 square inches |
262 |
235 |
$7K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
27 |
27 |
$6K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
375 |
363 |
$6K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
84 |
78 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
958 |
860 |
$4K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
29 |
27 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
104 |
103 |
$3K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
94 |
38 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,655 |
1,573 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
13 |
12 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
162 |
134 |
$2K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
27 |
26 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
144 |
141 |
$699.20 |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
18 |
13 |
$653.12 |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
13 |
12 |
$619.95 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
209 |
197 |
$562.86 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
32 |
25 |
$559.86 |
| A7037 |
Tubing used with positive airway pressure device |
67 |
65 |
$540.90 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
22 |
12 |
$538.40 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
12 |
12 |
$516.61 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
30 |
26 |
$192.48 |
| A4456 |
Adhesive remover, wipes, any type, each |
12 |
12 |
$62.68 |
| A4371 |
Ostomy skin barrier, powder, per oz |
25 |
24 |
$34.26 |