| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,172 |
3,947 |
$399K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,121 |
3,907 |
$376K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,398 |
3,192 |
$311K |
| A4554 |
Disposable underpads, all sizes |
9,403 |
8,941 |
$275K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,158 |
2,048 |
$97K |
| A4927 |
Gloves, non-sterile, per 100 |
5,339 |
5,001 |
$60K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,528 |
1,411 |
$59K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
703 |
620 |
$58K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,039 |
1,635 |
$57K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,090 |
2,820 |
$29K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
830 |
769 |
$23K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,070 |
1,022 |
$13K |
| K0001 |
Standard wheelchair |
473 |
442 |
$3K |
| K0002 |
Standard hemi (low seat) wheelchair |
175 |
165 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
58 |
50 |
$3K |
| E0570 |
Nebulizer, with compressor |
79 |
76 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
214 |
202 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,505 |
2,383 |
$1K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
13 |
12 |
$1K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
14 |
13 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
13 |
13 |
$381.03 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
930 |
901 |
$330.43 |
| A7037 |
Tubing used with positive airway pressure device |
113 |
101 |
$300.28 |
| A7035 |
Headgear used with positive airway pressure device |
125 |
110 |
$300.24 |
| E2203 |
Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches |
113 |
107 |
$228.32 |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
51 |
49 |
$202.78 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
32 |
29 |
$105.65 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
64 |
61 |
$73.97 |