| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,948 |
4,725 |
$266K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,817 |
1,754 |
$171K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
946 |
906 |
$121K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,347 |
1,281 |
$112K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,547 |
2,460 |
$102K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
356 |
334 |
$65K |
| 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 |
411 |
391 |
$50K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,193 |
1,189 |
$45K |
| A4927 |
Gloves, non-sterile, per 100 |
1,424 |
1,376 |
$30K |
| E0570 |
Nebulizer, with compressor |
144 |
143 |
$7K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
12 |
12 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
109 |
109 |
$955.26 |
| E1392 |
Portable oxygen concentrator, rental |
13 |
13 |
$93.24 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
19 |
19 |
$66.16 |
| A7015 |
Aerosol mask, used with dme nebulizer |
13 |
13 |
$18.07 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
13 |
13 |
$7.50 |