| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
19,387 |
17,823 |
$645K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,808 |
4,438 |
$327K |
| T5999 |
Supply, not otherwise specified |
34,345 |
28,355 |
$326K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,982 |
5,193 |
$304K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,145 |
4,663 |
$254K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,290 |
2,227 |
$253K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,451 |
1,291 |
$183K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,783 |
5,412 |
$173K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
831 |
724 |
$163K |
| X1939 |
|
2,368 |
2,093 |
$140K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,348 |
1,210 |
$104K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,875 |
1,553 |
$103K |
| K0001 |
Standard wheelchair |
2,338 |
2,192 |
$80K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,325 |
1,089 |
$80K |
| A4927 |
Gloves, non-sterile, per 100 |
7,181 |
5,039 |
$77K |
| X1915 |
|
390 |
380 |
$68K |
| E0601 |
Continuous positive airway pressure (cpap) device |
629 |
566 |
$40K |
| X1922 |
|
200 |
200 |
$35K |
| K0006 |
Heavy duty wheelchair |
633 |
591 |
$32K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
443 |
368 |
$28K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
84 |
81 |
$16K |
| E0570 |
Nebulizer, with compressor |
100 |
100 |
$13K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
367 |
345 |
$9K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
48 |
48 |
$4K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
54 |
50 |
$4K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
253 |
234 |
$4K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
48 |
39 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
76 |
76 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
42 |
38 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
101 |
89 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
12 |
12 |
$41.83 |
| A7015 |
Aerosol mask, used with dme nebulizer |
17 |
17 |
$27.52 |