| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4542 |
Incontinence product, disposable underpad, small size, each |
2,118 |
1,888 |
$76K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,696 |
2,791 |
$65K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
669 |
596 |
$38K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
324 |
309 |
$35K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
259 |
246 |
$33K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
288 |
262 |
$33K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,905 |
2,071 |
$17K |
| E0570 |
Nebulizer, with compressor |
2,375 |
1,949 |
$9K |
| 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 |
36 |
24 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
35 |
27 |
$3K |
| E0601 |
Continuous positive airway pressure (cpap) device |
237 |
173 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
194 |
167 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
206 |
144 |
$535.02 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
39 |
28 |
$31.23 |