| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4542 |
Incontinence product, disposable underpad, small size, each |
3,494 |
3,293 |
$140K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,337 |
1,263 |
$137K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,900 |
1,792 |
$114K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
959 |
889 |
$102K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
397 |
385 |
$54K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,395 |
3,621 |
$53K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,864 |
2,264 |
$10K |
| E0570 |
Nebulizer, with compressor |
1,844 |
1,534 |
$7K |
| K0001 |
Standard wheelchair |
582 |
443 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
192 |
142 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
244 |
233 |
$4K |
| 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 |
17 |
12 |
$1K |
| E0601 |
Continuous positive airway pressure (cpap) device |
45 |
38 |
$714.97 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
521 |
216 |
$619.45 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
76 |
61 |
$299.71 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
20 |
14 |
$45.91 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
16 |
12 |
$7.70 |