| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
1,780 |
1,464 |
$266K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,586 |
1,442 |
$146K |
| A4927 |
Gloves, non-sterile, per 100 |
4,808 |
4,668 |
$137K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,281 |
1,208 |
$132K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,123 |
1,030 |
$90K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
742 |
712 |
$89K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
404 |
370 |
$73K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,629 |
1,589 |
$64K |
| 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 |
361 |
294 |
$63K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
254 |
230 |
$57K |
| E0601 |
Continuous positive airway pressure (cpap) device |
509 |
496 |
$22K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
388 |
380 |
$20K |
| K0001 |
Standard wheelchair |
687 |
678 |
$16K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
108 |
96 |
$16K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
573 |
556 |
$10K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
123 |
123 |
$8K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,328 |
782 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
130 |
129 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
482 |
476 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
49 |
48 |
$2K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
54 |
54 |
$2K |
| E1399 |
Durable medical equipment, miscellaneous |
14 |
12 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
12 |
12 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
24 |
24 |
$812.91 |
| E0156 |
Seat attachment, walker |
12 |
12 |
$169.00 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
53 |
53 |
$49.30 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
14 |
14 |
$36.94 |