| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,637 |
1,620 |
$281K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,245 |
2,215 |
$144K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,247 |
2,215 |
$103K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
234 |
174 |
$37K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
142 |
141 |
$20K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
145 |
142 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
2,326 |
2,287 |
$17K |
| A4670 |
Automatic blood pressure monitor |
220 |
216 |
$13K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
30 |
30 |
$5K |
| 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 |
249 |
154 |
$5K |
| 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 |
250 |
155 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,098 |
1,068 |
$4K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
16 |
16 |
$2K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
125 |
125 |
$576.76 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
55 |
55 |
$456.49 |
| E0156 |
Seat attachment, walker |
62 |
62 |
$170.83 |
| E0570 |
Nebulizer, with compressor |
61 |
61 |
$147.92 |