| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,177 |
1,154 |
$917K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,399 |
5,351 |
$243K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,238 |
1,232 |
$237K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,648 |
1,634 |
$82K |
| E0570 |
Nebulizer, with compressor |
673 |
663 |
$77K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,119 |
1,111 |
$75K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
832 |
828 |
$64K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
945 |
942 |
$63K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
659 |
656 |
$45K |
| A4927 |
Gloves, non-sterile, per 100 |
1,227 |
1,200 |
$27K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
270 |
269 |
$17K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
165 |
164 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
655 |
648 |
$11K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
295 |
232 |
$10K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
256 |
253 |
$10K |
| A4217 |
Sterile water/saline, 500 ml |
49 |
49 |
$8K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
68 |
67 |
$7K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
412 |
407 |
$6K |
| E1392 |
Portable oxygen concentrator, rental |
166 |
165 |
$5K |
| A4402 |
Lubricant, per ounce |
806 |
791 |
$5K |
| A4335 |
Incontinence supply; miscellaneous |
401 |
395 |
$4K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
140 |
136 |
$4K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
53 |
51 |
$4K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
114 |
113 |
$4K |
| A4670 |
Automatic blood pressure monitor |
28 |
28 |
$3K |
| A6221 |
Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
24 |
24 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
42 |
42 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
13 |
13 |
$2K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
12 |
12 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
38 |
37 |
$1K |
| A4259 |
Lancets, per box of 100 |
42 |
42 |
$977.25 |
| A7015 |
Aerosol mask, used with dme nebulizer |
575 |
566 |
$719.42 |
| A4456 |
Adhesive remover, wipes, any type, each |
91 |
89 |
$636.40 |
| A5120 |
Skin barrier, wipes or swabs, each |
70 |
70 |
$628.00 |
| A7035 |
Headgear used with positive airway pressure device |
26 |
25 |
$368.86 |
| A7037 |
Tubing used with positive airway pressure device |
25 |
24 |
$340.07 |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$36.70 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
12 |
12 |
$8.20 |