| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,086 |
2,767 |
$122K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
614 |
586 |
$104K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
617 |
592 |
$94K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
575 |
546 |
$88K |
| A4927 |
Gloves, non-sterile, per 100 |
2,393 |
2,136 |
$43K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,365 |
1,234 |
$21K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
793 |
724 |
$19K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
212 |
212 |
$15K |
| A4553 |
Non-disposable underpads, all sizes |
1,043 |
920 |
$13K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
682 |
655 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
629 |
558 |
$6K |
| E0601 |
Continuous positive airway pressure (cpap) device |
477 |
452 |
$5K |
| E0570 |
Nebulizer, with compressor |
1,247 |
1,149 |
$4K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
724 |
714 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
787 |
743 |
$3K |
| K0001 |
Standard wheelchair |
404 |
360 |
$3K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
259 |
170 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
121 |
99 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
63 |
54 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
36 |
29 |
$1K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
25 |
19 |
$853.88 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
59 |
44 |
$555.12 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
37 |
30 |
$481.22 |
| A7037 |
Tubing used with positive airway pressure device |
46 |
41 |
$438.69 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
22 |
14 |
$432.00 |
| A4259 |
Lancets, per box of 100 |
87 |
80 |
$89.08 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
51 |
32 |
$83.13 |
| A7015 |
Aerosol mask, used with dme nebulizer |
20 |
13 |
$14.12 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
14 |
12 |
$0.00 |