| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4542 |
Incontinence product, disposable underpad, small size, each |
4,395 |
3,382 |
$155K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
923 |
650 |
$102K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
973 |
697 |
$100K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
385 |
291 |
$96K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,842 |
1,370 |
$89K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,498 |
1,694 |
$59K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
807 |
563 |
$57K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,441 |
1,126 |
$29K |
| A4927 |
Gloves, non-sterile, per 100 |
1,312 |
959 |
$17K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,386 |
977 |
$15K |
| K0001 |
Standard wheelchair |
532 |
387 |
$10K |
| E0570 |
Nebulizer, with compressor |
1,111 |
823 |
$7K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
818 |
608 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
255 |
205 |
$3K |
| 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 |
32 |
24 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
23 |
20 |
$3K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
162 |
117 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
48 |
30 |
$922.95 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
508 |
349 |
$674.72 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
699 |
274 |
$583.12 |
| A7035 |
Headgear used with positive airway pressure device |
79 |
63 |
$446.90 |