| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
10,247 |
10,184 |
$361K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,340 |
3,329 |
$339K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,806 |
1,790 |
$245K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
7,630 |
7,531 |
$230K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,541 |
2,530 |
$220K |
| E0570 |
Nebulizer, with compressor |
3,654 |
3,600 |
$114K |
| A4670 |
Automatic blood pressure monitor |
1,060 |
1,054 |
$62K |
| A4335 |
Incontinence supply; miscellaneous |
10,913 |
10,801 |
$59K |
| K0001 |
Standard wheelchair |
1,406 |
1,401 |
$13K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
216 |
210 |
$13K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,981 |
1,942 |
$9K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
270 |
269 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,083 |
1,055 |
$2K |
| A4617 |
Mouth piece |
554 |
537 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,059 |
1,027 |
$1K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
194 |
193 |
$921.11 |
| A4259 |
Lancets, per box of 100 |
1,458 |
1,436 |
$555.80 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
38 |
38 |
$410.48 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
46 |
45 |
$396.00 |
| E0305 |
Bed side rails, half length |
195 |
192 |
$134.29 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
89 |
89 |
$42.67 |
| E0156 |
Seat attachment, walker |
13 |
13 |
$14.52 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
12 |
12 |
$2.80 |
| 90480 |
|
16 |
16 |
$0.00 |
| 90686 |
|
15 |
15 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
19 |
19 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
17 |
17 |
$0.00 |
| 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 |
24 |
12 |
$0.00 |
| 91320 |
|
16 |
16 |
$0.00 |
| 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 |
24 |
12 |
$0.00 |