| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4542 |
Incontinence product, disposable underpad, small size, each |
8,592 |
7,924 |
$329K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,698 |
2,440 |
$296K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,950 |
2,597 |
$271K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,231 |
3,974 |
$240K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,700 |
1,574 |
$219K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
743 |
706 |
$204K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,664 |
2,732 |
$135K |
| 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 |
1,378 |
965 |
$125K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
789 |
568 |
$36K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,004 |
1,605 |
$31K |
| A4927 |
Gloves, non-sterile, per 100 |
1,728 |
1,516 |
$24K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
153 |
138 |
$13K |
| K0001 |
Standard wheelchair |
633 |
487 |
$12K |
| E0570 |
Nebulizer, with compressor |
1,581 |
1,353 |
$9K |
| 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 |
46 |
26 |
$7K |
| E0601 |
Continuous positive airway pressure (cpap) device |
317 |
250 |
$6K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,640 |
604 |
$2K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
18 |
18 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
191 |
136 |
$1K |
| A4670 |
Automatic blood pressure monitor |
32 |
24 |
$940.00 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
70 |
50 |
$355.65 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
26 |
24 |
$301.32 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
15 |
13 |
$299.20 |
| 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 |
59 |
14 |
$184.28 |
| 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 |
57 |
13 |
$75.20 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
40 |
24 |
$62.19 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
16 |
12 |
$23.15 |