| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
18,356 |
15,997 |
$606K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,255 |
4,525 |
$368K |
| X1939 |
|
5,414 |
5,358 |
$334K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,065 |
1,802 |
$275K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,993 |
4,651 |
$265K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,936 |
4,299 |
$235K |
| T5999 |
Supply, not otherwise specified |
28,593 |
23,799 |
$232K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,011 |
1,571 |
$208K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,877 |
2,750 |
$184K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
1,283 |
1,212 |
$115K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,670 |
1,252 |
$98K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,079 |
1,924 |
$97K |
| E0570 |
Nebulizer, with compressor |
3,341 |
2,839 |
$93K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,222 |
3,002 |
$91K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,218 |
932 |
$90K |
| X1922 |
|
572 |
551 |
$76K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,301 |
2,218 |
$67K |
| X1915 |
|
685 |
665 |
$62K |
| K0001 |
Standard wheelchair |
3,669 |
3,269 |
$60K |
| A4927 |
Gloves, non-sterile, per 100 |
3,558 |
2,000 |
$39K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,802 |
2,577 |
$32K |
| 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 |
694 |
359 |
$27K |
| 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 |
720 |
372 |
$23K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
783 |
736 |
$15K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,230 |
1,203 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
688 |
636 |
$8K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
445 |
400 |
$8K |
| A7030 |
Full face mask used with positive airway pressure device, each |
88 |
77 |
$5K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
94 |
89 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,457 |
1,366 |
$3K |
| A4259 |
Lancets, per box of 100 |
977 |
955 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
137 |
123 |
$836.45 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
16 |
15 |
$540.20 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
16 |
14 |
$404.85 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
40 |
40 |
$232.86 |
| A7015 |
Aerosol mask, used with dme nebulizer |
13 |
13 |
$22.85 |