| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
61,206 |
59,224 |
$3.84M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
52,140 |
50,357 |
$3.11M |
| A4554 |
Disposable underpads, all sizes |
88,835 |
86,733 |
$2.07M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
27,214 |
26,450 |
$1.83M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
38,313 |
37,307 |
$1.76M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
9,983 |
9,654 |
$920K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
9,152 |
8,859 |
$673K |
| A4335 |
Incontinence supply; miscellaneous |
101,012 |
99,130 |
$654K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
9,146 |
8,786 |
$543K |
| 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 |
3,652 |
3,460 |
$373K |
| A4927 |
Gloves, non-sterile, per 100 |
75,166 |
73,138 |
$321K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,676 |
4,474 |
$307K |
| 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 |
1,703 |
1,630 |
$238K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
49,075 |
47,782 |
$235K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,825 |
1,722 |
$213K |
| A4245 |
Alcohol wipes, per box |
33,516 |
31,869 |
$182K |
| S5199 |
Personal care item, nos, each |
2,816 |
2,684 |
$97K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
618 |
519 |
$71K |
| A5120 |
Skin barrier, wipes or swabs, each |
9,536 |
8,814 |
$54K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
390 |
360 |
$41K |
| E0570 |
Nebulizer, with compressor |
308 |
290 |
$17K |
| K0001 |
Standard wheelchair |
493 |
446 |
$12K |
| T4541 |
Incontinence product, disposable underpad, large, each |
521 |
410 |
$11K |
| E0601 |
Continuous positive airway pressure (cpap) device |
159 |
156 |
$8K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
56 |
53 |
$7K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
62 |
61 |
$4K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
441 |
437 |
$4K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
13 |
13 |
$1K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
161 |
159 |
$953.90 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
13 |
12 |
$659.45 |
| B4100 |
Food thickener, administered orally, per ounce |
12 |
12 |
$618.69 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
95 |
81 |
$374.49 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
139 |
132 |
$357.21 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
16 |
15 |
$323.60 |
| A7015 |
Aerosol mask, used with dme nebulizer |
92 |
89 |
$188.25 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
31 |
24 |
$29.88 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
13 |
13 |
$11.75 |