| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,117 |
7,887 |
$443K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,415 |
7,407 |
$407K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,382 |
3,315 |
$340K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,875 |
2,766 |
$264K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,891 |
1,845 |
$215K |
| E0570 |
Nebulizer, with compressor |
4,016 |
4,005 |
$182K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,823 |
3,708 |
$144K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
666 |
643 |
$110K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
548 |
514 |
$102K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,595 |
5,591 |
$56K |
| A4927 |
Gloves, non-sterile, per 100 |
1,880 |
1,806 |
$51K |
| K0001 |
Standard wheelchair |
2,363 |
2,354 |
$48K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,780 |
1,766 |
$48K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
331 |
324 |
$21K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
1,080 |
1,080 |
$16K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
457 |
440 |
$15K |
| E0601 |
Continuous positive airway pressure (cpap) device |
145 |
141 |
$9K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,453 |
2,452 |
$9K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
167 |
167 |
$8K |
| 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 |
72 |
67 |
$8K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
25 |
24 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
115 |
109 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,754 |
1,754 |
$3K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
934 |
934 |
$3K |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
713 |
713 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
262 |
261 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
239 |
239 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,019 |
1,013 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
98 |
98 |
$920.51 |
| A7030 |
Full face mask used with positive airway pressure device, each |
14 |
14 |
$555.80 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
12 |
12 |
$187.42 |