| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,276 |
2,056 |
$200K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,718 |
3,317 |
$149K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,853 |
1,583 |
$138K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,703 |
1,550 |
$119K |
| A4554 |
Disposable underpads, all sizes |
3,051 |
2,771 |
$116K |
| 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 |
1,495 |
1,041 |
$87K |
| A4927 |
Gloves, non-sterile, per 100 |
3,914 |
2,753 |
$62K |
| E0570 |
Nebulizer, with compressor |
1,572 |
1,398 |
$35K |
| K0001 |
Standard wheelchair |
1,726 |
1,433 |
$34K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
211 |
186 |
$20K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
73 |
60 |
$8K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
841 |
736 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
110 |
104 |
$6K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
110 |
86 |
$3K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
34 |
28 |
$2K |
| E0156 |
Seat attachment, walker |
237 |
188 |
$1K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
245 |
206 |
$537.22 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
87 |
73 |
$521.09 |
| A4259 |
Lancets, per box of 100 |
277 |
247 |
$268.15 |
| A4500 |
Surgical stockings below knee length, each |
15 |
12 |
$197.40 |