| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
26,490 |
26,300 |
$830K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
3,978 |
3,953 |
$811K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,033 |
7,001 |
$769K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
14,270 |
14,179 |
$555K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,298 |
5,247 |
$505K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,990 |
1,966 |
$166K |
| A4335 |
Incontinence supply; miscellaneous |
30,077 |
29,815 |
$142K |
| E0570 |
Nebulizer, with compressor |
3,026 |
2,948 |
$112K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
412 |
412 |
$101K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
875 |
849 |
$84K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
567 |
563 |
$52K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
1,114 |
933 |
$20K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,992 |
1,967 |
$8K |
| A4670 |
Automatic blood pressure monitor |
126 |
126 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
411 |
411 |
$7K |
| K0001 |
Standard wheelchair |
746 |
739 |
$6K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
26 |
26 |
$5K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
38 |
38 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,208 |
2,150 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,244 |
2,170 |
$2K |
| 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 |
770 |
614 |
$962.17 |
| 87428 |
|
44 |
41 |
$955.37 |
| A4259 |
Lancets, per box of 100 |
1,967 |
1,951 |
$719.02 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
149 |
144 |
$464.45 |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
13 |
12 |
$456.00 |
| 90686 |
|
399 |
396 |
$418.33 |
| 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 |
768 |
613 |
$305.42 |
| A4245 |
Alcohol wipes, per box |
93 |
92 |
$180.06 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
100 |
100 |
$81.13 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
28 |
27 |
$79.26 |
| 0064A |
|
88 |
88 |
$18.00 |
| 0094A |
|
17 |
16 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
306 |
305 |
$0.00 |
| 90674 |
|
58 |
58 |
$0.00 |
| 0134A |
|
17 |
17 |
$0.00 |
| 0013A |
|
15 |
15 |
$0.00 |