| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
5,571 |
5,092 |
$212K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,754 |
1,655 |
$183K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,686 |
1,594 |
$183K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,965 |
1,641 |
$180K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,609 |
1,477 |
$168K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,258 |
1,168 |
$122K |
| 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 |
1,318 |
1,119 |
$115K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,493 |
1,339 |
$65K |
| A4927 |
Gloves, non-sterile, per 100 |
4,642 |
4,215 |
$58K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
107 |
64 |
$12K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
50 |
50 |
$10K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
182 |
166 |
$7K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
12 |
12 |
$3K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
137 |
120 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
46 |
39 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
13 |
12 |
$1K |