| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,246 |
4,134 |
$270K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,362 |
1,329 |
$169K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,674 |
1,642 |
$159K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,481 |
1,457 |
$157K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,615 |
2,576 |
$138K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
598 |
572 |
$109K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
462 |
450 |
$84K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
323 |
323 |
$34K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
324 |
315 |
$26K |
| E1399 |
Durable medical equipment, miscellaneous |
279 |
269 |
$25K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
110 |
104 |
$20K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
212 |
212 |
$19K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
87 |
82 |
$15K |
| A4335 |
Incontinence supply; miscellaneous |
180 |
145 |
$14K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
300 |
296 |
$13K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
104 |
95 |
$13K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
358 |
355 |
$13K |
| E0241 |
Bath tub wall rail, each |
80 |
54 |
$9K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
104 |
104 |
$9K |
| A4927 |
Gloves, non-sterile, per 100 |
194 |
162 |
$6K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
100 |
100 |
$5K |
| K0001 |
Standard wheelchair |
185 |
184 |
$4K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
12 |
12 |
$4K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
27 |
27 |
$4K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
15 |
12 |
$3K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
18 |
18 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
64 |
64 |
$2K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
18 |
18 |
$1K |
| E0244 |
Raised toilet seat |
14 |
14 |
$1K |
| K0003 |
Lightweight wheelchair |
89 |
89 |
$918.59 |
| E0246 |
Transfer tub rail attachment |
13 |
13 |
$825.00 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
25 |
25 |
$476.37 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
107 |
107 |
$409.79 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
12 |
12 |
$40.04 |