| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,943 |
3,933 |
$158K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,223 |
2,162 |
$143K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,155 |
2,144 |
$127K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,730 |
1,721 |
$88K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,544 |
1,537 |
$71K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
760 |
757 |
$44K |
| E0601 |
Continuous positive airway pressure (cpap) device |
666 |
662 |
$40K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,027 |
998 |
$15K |
| K0001 |
Standard wheelchair |
597 |
585 |
$13K |
| A4927 |
Gloves, non-sterile, per 100 |
2,638 |
2,633 |
$9K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
680 |
680 |
$9K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
13 |
13 |
$837.64 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
183 |
179 |
$802.06 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
14 |
$451.97 |
| A7035 |
Headgear used with positive airway pressure device |
12 |
12 |
$134.20 |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
26 |
24 |
$122.59 |
| A7037 |
Tubing used with positive airway pressure device |
14 |
14 |
$100.89 |
| A4335 |
Incontinence supply; miscellaneous |
54 |
54 |
$64.26 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14 |
14 |
$23.16 |