| 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 |
4,984 |
4,358 |
$159K |
| A4927 |
Gloves, non-sterile, per 100 |
4,772 |
4,391 |
$106K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
734 |
671 |
$84K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,114 |
1,983 |
$80K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
356 |
348 |
$49K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,698 |
3,280 |
$42K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
272 |
265 |
$32K |
| E0601 |
Continuous positive airway pressure (cpap) device |
660 |
616 |
$31K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,559 |
1,469 |
$29K |
| E0570 |
Nebulizer, with compressor |
3,989 |
3,561 |
$17K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
3,614 |
3,200 |
$16K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
663 |
616 |
$14K |
| A7037 |
Tubing used with positive airway pressure device |
1,274 |
1,194 |
$11K |
| A7030 |
Full face mask used with positive airway pressure device, each |
193 |
181 |
$11K |
| A7035 |
Headgear used with positive airway pressure device |
658 |
613 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,035 |
1,915 |
$8K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
12 |
12 |
$2K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
887 |
702 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
27 |
26 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
28 |
25 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
71 |
67 |
$816.19 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
196 |
185 |
$440.40 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
14 |
12 |
$373.53 |
| A4553 |
Non-disposable underpads, all sizes |
12 |
12 |
$167.51 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
27 |
25 |
$118.06 |
| A7015 |
Aerosol mask, used with dme nebulizer |
40 |
37 |
$110.87 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
13 |
13 |
$30.24 |