| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
1,935 |
1,398 |
$329K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,969 |
3,440 |
$325K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
830 |
792 |
$184K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,189 |
2,003 |
$134K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,130 |
1,095 |
$117K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
821 |
774 |
$97K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
964 |
939 |
$89K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,136 |
1,957 |
$88K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
866 |
805 |
$53K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,929 |
2,559 |
$52K |
| E0570 |
Nebulizer, with compressor |
1,299 |
1,149 |
$38K |
| T4541 |
Incontinence product, disposable underpad, large, each |
765 |
748 |
$29K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
1,065 |
1,025 |
$28K |
| K0001 |
Standard wheelchair |
871 |
831 |
$27K |
| A7031 |
Face mask interface, replacement for full face mask, each |
387 |
376 |
$15K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
109 |
101 |
$11K |
| A4927 |
Gloves, non-sterile, per 100 |
395 |
388 |
$10K |
| A7030 |
Full face mask used with positive airway pressure device, each |
74 |
74 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
234 |
229 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
952 |
891 |
$4K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
18 |
18 |
$4K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
109 |
107 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
44 |
42 |
$3K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
32 |
28 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
144 |
139 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
44 |
43 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
448 |
436 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
12 |
12 |
$778.45 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
43 |
40 |
$551.81 |