| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,502 |
1,436 |
$178K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,629 |
6,135 |
$154K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
3,675 |
3,512 |
$145K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,096 |
1,963 |
$123K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,248 |
1,142 |
$123K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
781 |
729 |
$103K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
951 |
704 |
$89K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,110 |
903 |
$37K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,692 |
3,868 |
$29K |
| K0001 |
Standard wheelchair |
1,428 |
1,134 |
$25K |
| A4927 |
Gloves, non-sterile, per 100 |
1,312 |
1,204 |
$17K |
| E0570 |
Nebulizer, with compressor |
2,515 |
2,087 |
$11K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
39 |
36 |
$11K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
216 |
173 |
$9K |
| E0601 |
Continuous positive airway pressure (cpap) device |
555 |
463 |
$8K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,147 |
890 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
284 |
228 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
106 |
85 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
411 |
307 |
$764.34 |
| A7035 |
Headgear used with positive airway pressure device |
65 |
50 |
$316.83 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
17 |
12 |
$192.67 |
| A7037 |
Tubing used with positive airway pressure device |
18 |
16 |
$101.89 |