| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,701 |
4,111 |
$157K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,675 |
1,878 |
$72K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,961 |
1,292 |
$65K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,380 |
2,977 |
$49K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
415 |
388 |
$21K |
| E0570 |
Nebulizer, with compressor |
681 |
647 |
$16K |
| A4927 |
Gloves, non-sterile, per 100 |
1,589 |
900 |
$15K |
| K0001 |
Standard wheelchair |
720 |
675 |
$13K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
147 |
137 |
$530.91 |
| A4670 |
Automatic blood pressure monitor |
13 |
12 |
$383.05 |
| 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 |
63 |
16 |
$363.96 |
| 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 |
64 |
17 |
$360.88 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
12 |
12 |
$34.03 |