| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
11,002 |
10,711 |
$728K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,264 |
3,180 |
$527K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,777 |
3,624 |
$486K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,785 |
9,526 |
$457K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,382 |
1,335 |
$351K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,744 |
1,710 |
$230K |
| A4927 |
Gloves, non-sterile, per 100 |
8,733 |
8,291 |
$72K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
110 |
108 |
$13K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
104 |
104 |
$6K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
38 |
37 |
$4K |
| K0001 |
Standard wheelchair |
287 |
286 |
$3K |
| E0570 |
Nebulizer, with compressor |
41 |
41 |
$2K |
| A4670 |
Automatic blood pressure monitor |
14 |
14 |
$830.21 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
181 |
181 |
$428.45 |
| 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 |
26 |
13 |
$352.24 |
| 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 |
26 |
13 |
$304.80 |
| E0156 |
Seat attachment, walker |
37 |
36 |
$257.27 |