| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,918 |
1,848 |
$146K |
| E0570 |
Nebulizer, with compressor |
3,120 |
2,857 |
$86K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,113 |
1,068 |
$69K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,278 |
2,035 |
$68K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
972 |
918 |
$61K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
242 |
227 |
$56K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
763 |
703 |
$51K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,373 |
2,083 |
$47K |
| A4215 |
Needle, sterile, any size, each |
1,517 |
1,403 |
$30K |
| E0601 |
Continuous positive airway pressure (cpap) device |
573 |
512 |
$24K |
| A4554 |
Disposable underpads, all sizes |
810 |
772 |
$14K |
| 91320 |
|
112 |
107 |
$12K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
611 |
576 |
$12K |
| 0002A |
|
283 |
277 |
$11K |
| 0001A |
|
314 |
309 |
$10K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
136 |
65 |
$5K |
| 0004A |
|
142 |
136 |
$5K |
| G0008 |
Administration of influenza virus vaccine |
315 |
297 |
$5K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
27 |
24 |
$5K |
| A4259 |
Lancets, per box of 100 |
1,139 |
1,055 |
$4K |
| 90674 |
|
184 |
172 |
$4K |
| 90480 |
|
116 |
111 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,657 |
1,565 |
$3K |
| 0124A |
|
81 |
75 |
$3K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
27 |
25 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
354 |
336 |
$2K |
| A4670 |
Automatic blood pressure monitor |
47 |
47 |
$2K |
| 90686 |
|
105 |
99 |
$2K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
39 |
36 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
422 |
406 |
$2K |
| 0031A |
|
40 |
32 |
$1K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
43 |
42 |
$906.00 |
| 0134A |
|
23 |
23 |
$880.00 |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
15 |
12 |
$845.57 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
53 |
51 |
$814.02 |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
13 |
12 |
$735.36 |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
12 |
12 |
$640.56 |
| 0012A |
|
19 |
19 |
$567.46 |
| 90661 |
|
22 |
22 |
$556.58 |
| E0607 |
Home blood glucose monitor |
19 |
15 |
$493.71 |
| A7037 |
Tubing used with positive airway pressure device |
68 |
66 |
$478.06 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
58 |
49 |
$421.94 |
| 0011A |
|
21 |
21 |
$421.04 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
27 |
26 |
$410.73 |
| A7035 |
Headgear used with positive airway pressure device |
12 |
12 |
$387.28 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
64 |
54 |
$178.15 |
| A4258 |
Spring-powered device for lancet, each |
57 |
44 |
$80.11 |
| A7015 |
Aerosol mask, used with dme nebulizer |
12 |
12 |
$16.16 |
| 91300 |
|
844 |
692 |
$0.00 |
| 91313 |
|
13 |
13 |
$0.00 |
| 91312 |
|
39 |
36 |
$0.00 |
| A9270 |
Non-covered item or service |
78 |
75 |
$0.00 |
| 91301 |
|
38 |
36 |
$0.00 |
| 91303 |
|
38 |
32 |
$0.00 |
| 91305 |
|
18 |
15 |
$0.00 |