| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,771 |
1,575 |
$197K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
4,812 |
4,462 |
$182K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,330 |
1,237 |
$175K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,577 |
1,435 |
$161K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,231 |
2,082 |
$132K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,572 |
4,378 |
$130K |
| 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 |
807 |
587 |
$60K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
180 |
171 |
$47K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,164 |
941 |
$39K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,558 |
2,941 |
$33K |
| A4927 |
Gloves, non-sterile, per 100 |
1,906 |
1,621 |
$25K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,032 |
867 |
$18K |
| E0570 |
Nebulizer, with compressor |
2,750 |
2,328 |
$11K |
| K0001 |
Standard wheelchair |
588 |
475 |
$9K |
| 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) |
94 |
79 |
$5K |
| A7030 |
Full face mask used with positive airway pressure device, each |
164 |
136 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
260 |
190 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
989 |
802 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,377 |
601 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
135 |
117 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
114 |
95 |
$754.80 |
| A7031 |
Face mask interface, replacement for full face mask, each |
39 |
36 |
$747.82 |
| A7037 |
Tubing used with positive airway pressure device |
14 |
13 |
$87.71 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
17 |
12 |
$87.00 |