| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
1,983 |
836 |
$686K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,095 |
3,670 |
$247K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,520 |
1,438 |
$168K |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
3,164 |
2,783 |
$135K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,362 |
1,300 |
$112K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
3,185 |
2,946 |
$96K |
| A4554 |
Disposable underpads, all sizes |
2,149 |
2,058 |
$66K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,547 |
1,454 |
$64K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
313 |
297 |
$28K |
| A4927 |
Gloves, non-sterile, per 100 |
668 |
564 |
$13K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
306 |
232 |
$706.74 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
87 |
74 |
$238.38 |