| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
17,168 |
16,861 |
$723K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,406 |
3,350 |
$468K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,796 |
1,784 |
$369K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,601 |
2,565 |
$313K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,035 |
977 |
$263K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,207 |
5,091 |
$230K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,470 |
1,419 |
$192K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,342 |
1,321 |
$125K |
| A4335 |
Incontinence supply; miscellaneous |
18,132 |
17,500 |
$94K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
16,257 |
15,747 |
$74K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
383 |
367 |
$36K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
198 |
198 |
$21K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,300 |
1,270 |
$11K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
43 |
37 |
$5K |
| A4245 |
Alcohol wipes, per box |
1,610 |
1,597 |
$3K |
| 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 |
12 |
12 |
$3K |
| A4259 |
Lancets, per box of 100 |
1,273 |
1,263 |
$2K |
| K0004 |
High strength, lightweight wheelchair |
84 |
84 |
$594.43 |
| A4927 |
Gloves, non-sterile, per 100 |
47 |
45 |
$302.15 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
103 |
102 |
$247.46 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
83 |
83 |
$138.32 |
| A7015 |
Aerosol mask, used with dme nebulizer |
115 |
114 |
$99.12 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
13 |
12 |
$86.60 |
| E0607 |
Home blood glucose monitor |
17 |
17 |
$58.36 |
| A4256 |
Normal, low and high calibrator solution / chips |
36 |
36 |
$40.83 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
116 |
114 |
$19.59 |
| A4258 |
Spring-powered device for lancet, each |
12 |
12 |
$5.04 |
| A4233 |
Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each |
12 |
12 |
$2.40 |