| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,181 |
2,975 |
$209K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,175 |
1,109 |
$142K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,175 |
1,136 |
$119K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
936 |
902 |
$97K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,236 |
1,161 |
$38K |
| E0601 |
Continuous positive airway pressure (cpap) device |
148 |
144 |
$27K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
363 |
346 |
$27K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
621 |
569 |
$19K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
124 |
123 |
$19K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
271 |
267 |
$15K |
| A4927 |
Gloves, non-sterile, per 100 |
2,302 |
2,115 |
$9K |
| K0003 |
Lightweight wheelchair |
305 |
304 |
$4K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
31 |
31 |
$3K |
| K0001 |
Standard wheelchair |
200 |
200 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
61 |
61 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
305 |
305 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
21 |
21 |
$2K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
15 |
12 |
$934.54 |
| A7031 |
Face mask interface, replacement for full face mask, each |
20 |
20 |
$842.08 |
| A7035 |
Headgear used with positive airway pressure device |
72 |
72 |
$592.92 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
466 |
465 |
$412.82 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
12 |
12 |
$402.00 |
| A7037 |
Tubing used with positive airway pressure device |
55 |
55 |
$397.48 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
197 |
197 |
$365.31 |
| A4402 |
Lubricant, per ounce |
43 |
36 |
$130.32 |
| A7036 |
Chinstrap used with positive airway pressure device |
12 |
12 |
$98.92 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
32 |
32 |
$24.36 |