| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,431 |
3,360 |
$259K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,542 |
2,459 |
$232K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,981 |
1,918 |
$201K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,125 |
4,914 |
$198K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
5,287 |
5,125 |
$118K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,728 |
2,640 |
$84K |
| 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 |
666 |
626 |
$54K |
| A4927 |
Gloves, non-sterile, per 100 |
4,723 |
4,579 |
$50K |
| 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 |
266 |
249 |
$27K |
| E0601 |
Continuous positive airway pressure (cpap) device |
443 |
425 |
$17K |
| E0570 |
Nebulizer, with compressor |
740 |
715 |
$12K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
565 |
553 |
$7K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
509 |
483 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
38 |
38 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14 |
14 |
$1K |
| K0001 |
Standard wheelchair |
65 |
65 |
$594.64 |
| A7035 |
Headgear used with positive airway pressure device |
36 |
36 |
$518.03 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
152 |
145 |
$394.93 |
| A4259 |
Lancets, per box of 100 |
79 |
75 |
$57.90 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
29 |
26 |
$22.18 |