| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
95 |
95 |
$51.66 |
| T4541 |
Incontinence product, disposable underpad, large, each |
497 |
491 |
$0.00 |
| E0601 |
Continuous positive airway pressure (cpap) device |
326 |
326 |
$0.00 |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
480 |
480 |
$0.00 |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
160 |
160 |
$0.00 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
160 |
158 |
$0.00 |
| A4927 |
Gloves, non-sterile, per 100 |
71 |
66 |
$0.00 |
| A7035 |
Headgear used with positive airway pressure device |
61 |
61 |
$0.00 |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
208 |
208 |
$0.00 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
24 |
24 |
$0.00 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
150 |
150 |
$0.00 |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
117 |
117 |
$0.00 |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
13 |
12 |
$0.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
15 |
15 |
$0.00 |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
38 |
38 |
$0.00 |
| E0570 |
Nebulizer, with compressor |
787 |
782 |
$0.00 |
| A7015 |
Aerosol mask, used with dme nebulizer |
32 |
27 |
$0.00 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
507 |
507 |
$0.00 |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
82 |
82 |
$0.00 |
| A7037 |
Tubing used with positive airway pressure device |
26 |
24 |
$0.00 |
| 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) |
111 |
111 |
$0.00 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
400 |
391 |
$0.00 |
| K0001 |
Standard wheelchair |
544 |
544 |
$0.00 |
| E1392 |
Portable oxygen concentrator, rental |
24 |
24 |
$0.00 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
269 |
257 |
$0.00 |
| E0271 |
Mattress, innerspring |
126 |
124 |
$0.00 |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
39 |
39 |
$0.00 |
| A5120 |
Skin barrier, wipes or swabs, each |
40 |
38 |
$0.00 |
| E0305 |
Bed side rails, half length |
212 |
210 |
$0.00 |
| A4335 |
Incontinence supply; miscellaneous |
26 |
26 |
$0.00 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
24 |
24 |
$0.00 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
15 |
15 |
$0.00 |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
29 |
29 |
$0.00 |