| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,364 |
5,253 |
$289K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,928 |
4,924 |
$283K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,118 |
2,099 |
$194K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,891 |
1,870 |
$177K |
| E0570 |
Nebulizer, with compressor |
3,611 |
3,610 |
$171K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,512 |
3,465 |
$121K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,006 |
995 |
$110K |
| E1392 |
Portable oxygen concentrator, rental |
3,773 |
3,771 |
$63K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,356 |
1,356 |
$59K |
| K0001 |
Standard wheelchair |
2,244 |
2,243 |
$58K |
| A7030 |
Full face mask used with positive airway pressure device, each |
687 |
687 |
$52K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
102 |
102 |
$20K |
| A4927 |
Gloves, non-sterile, per 100 |
537 |
519 |
$20K |
| A7037 |
Tubing used with positive airway pressure device |
1,191 |
1,191 |
$16K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
68 |
66 |
$15K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
78 |
76 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
781 |
780 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
666 |
665 |
$12K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
432 |
432 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,042 |
2,037 |
$7K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
82 |
82 |
$6K |
| A7031 |
Face mask interface, replacement for full face mask, each |
707 |
706 |
$5K |
| A4335 |
Incontinence supply; miscellaneous |
439 |
431 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
87 |
87 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
653 |
613 |
$1K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
221 |
219 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
14 |
$577.17 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
163 |
163 |
$466.93 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
27 |
27 |
$222.85 |
| A7015 |
Aerosol mask, used with dme nebulizer |
12 |
12 |
$16.68 |
| A4259 |
Lancets, per box of 100 |
86 |
82 |
$16.61 |