| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,766 |
2,482 |
$348K |
| A4554 |
Disposable underpads, all sizes |
6,439 |
5,643 |
$341K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,417 |
3,568 |
$260K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,078 |
1,774 |
$225K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,517 |
1,362 |
$187K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,182 |
1,072 |
$158K |
| A4927 |
Gloves, non-sterile, per 100 |
4,410 |
3,921 |
$156K |
| E0570 |
Nebulizer, with compressor |
3,999 |
3,218 |
$144K |
| 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 |
1,187 |
831 |
$115K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,824 |
2,118 |
$62K |
| K0001 |
Standard wheelchair |
5,250 |
3,844 |
$52K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,105 |
910 |
$43K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,635 |
2,950 |
$35K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
272 |
218 |
$27K |
| A4335 |
Incontinence supply; miscellaneous |
3,352 |
2,979 |
$24K |
| L0450 |
Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf |
183 |
144 |
$21K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
598 |
470 |
$17K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
66 |
65 |
$11K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
79 |
63 |
$8K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
62 |
51 |
$6K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
118 |
94 |
$5K |
| A4670 |
Automatic blood pressure monitor |
77 |
65 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
263 |
237 |
$4K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
508 |
420 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
183 |
168 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
991 |
834 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,263 |
1,058 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
163 |
112 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
25 |
25 |
$2K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
13 |
12 |
$2K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
13 |
12 |
$2K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
25 |
12 |
$1K |
| E0156 |
Seat attachment, walker |
195 |
162 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
69 |
52 |
$1K |
| K0003 |
Lightweight wheelchair |
131 |
97 |
$939.89 |
| A7015 |
Aerosol mask, used with dme nebulizer |
361 |
287 |
$533.97 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
30 |
24 |
$331.69 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
14 |
12 |
$291.36 |
| A4259 |
Lancets, per box of 100 |
250 |
192 |
$256.79 |