| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,673 |
1,641 |
$198K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,203 |
1,180 |
$190K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
916 |
889 |
$113K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
514 |
499 |
$105K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
841 |
813 |
$91K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,172 |
1,153 |
$54K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
873 |
849 |
$50K |
| A4927 |
Gloves, non-sterile, per 100 |
1,537 |
1,488 |
$46K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
171 |
169 |
$40K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
675 |
530 |
$31K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
135 |
133 |
$28K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
496 |
469 |
$28K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
124 |
121 |
$26K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
164 |
90 |
$26K |
| K0001 |
Standard wheelchair |
951 |
912 |
$25K |
| E0601 |
Continuous positive airway pressure (cpap) device |
278 |
273 |
$13K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
187 |
185 |
$10K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
13 |
13 |
$7K |
| 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 |
62 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
28 |
28 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
252 |
250 |
$4K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
12 |
12 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
14 |
14 |
$501.97 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
13 |
13 |
$484.09 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
54 |
54 |
$258.02 |