| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,217 |
1,139 |
$130K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
703 |
669 |
$87K |
| 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 |
1,314 |
1,003 |
$76K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,813 |
1,666 |
$71K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,301 |
1,212 |
$70K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,061 |
1,893 |
$64K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
468 |
456 |
$52K |
| E0570 |
Nebulizer, with compressor |
1,744 |
1,639 |
$43K |
| A4670 |
Automatic blood pressure monitor |
1,148 |
1,073 |
$37K |
| K0001 |
Standard wheelchair |
1,402 |
1,307 |
$30K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
169 |
156 |
$25K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
82 |
77 |
$23K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,052 |
980 |
$17K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
169 |
169 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
399 |
373 |
$15K |
| 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 |
187 |
143 |
$14K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
378 |
344 |
$11K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
425 |
263 |
$8K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
251 |
173 |
$6K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
54 |
54 |
$5K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
130 |
127 |
$4K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
698 |
667 |
$3K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
150 |
71 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
53 |
53 |
$827.30 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
27 |
24 |
$674.26 |
| A7035 |
Headgear used with positive airway pressure device |
26 |
26 |
$451.79 |
| A7037 |
Tubing used with positive airway pressure device |
13 |
13 |
$154.78 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
16 |
15 |
$99.73 |
| E0156 |
Seat attachment, walker |
15 |
13 |
$75.00 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
16 |
15 |
$26.66 |