| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
4,565 |
4,557 |
$219K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,373 |
1,372 |
$161K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,538 |
1,536 |
$71K |
| K0001 |
Standard wheelchair |
1,175 |
1,161 |
$54K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
882 |
882 |
$50K |
| K0003 |
Lightweight wheelchair |
578 |
565 |
$25K |
| E0601 |
Continuous positive airway pressure (cpap) device |
168 |
168 |
$25K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
309 |
309 |
$13K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
334 |
329 |
$13K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
158 |
158 |
$13K |
| E0570 |
Nebulizer, with compressor |
223 |
222 |
$12K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
329 |
329 |
$7K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
160 |
158 |
$6K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
13 |
13 |
$6K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
101 |
101 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
111 |
109 |
$3K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
363 |
352 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
200 |
198 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
42 |
42 |
$1K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
15 |
15 |
$840.79 |
| E0156 |
Seat attachment, walker |
150 |
149 |
$754.28 |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
12 |
12 |
$696.14 |
| E0245 |
Tub stool or bench |
13 |
13 |
$691.65 |
| A7037 |
Tubing used with positive airway pressure device |
28 |
28 |
$664.36 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
27 |
27 |
$247.28 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
21 |
14 |
$11.46 |
| A7015 |
Aerosol mask, used with dme nebulizer |
14 |
14 |
$3.57 |