| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
15,596 |
15,451 |
$552K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,509 |
4,483 |
$496K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,705 |
3,677 |
$322K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
7,530 |
7,404 |
$248K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,730 |
1,721 |
$218K |
| A4335 |
Incontinence supply; miscellaneous |
17,681 |
17,449 |
$93K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
915 |
903 |
$23K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
219 |
218 |
$22K |
| E0570 |
Nebulizer, with compressor |
982 |
965 |
$20K |
| 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 |
249 |
244 |
$17K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
393 |
390 |
$6K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
73 |
72 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
50 |
50 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,052 |
1,044 |
$4K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
36 |
36 |
$3K |
| K0001 |
Standard wheelchair |
419 |
419 |
$3K |
| A4670 |
Automatic blood pressure monitor |
25 |
25 |
$2K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
13 |
13 |
$917.47 |
| E0601 |
Continuous positive airway pressure (cpap) device |
28 |
26 |
$601.11 |
| A7037 |
Tubing used with positive airway pressure device |
27 |
27 |
$263.60 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
200 |
195 |
$261.27 |
| A4259 |
Lancets, per box of 100 |
522 |
520 |
$210.94 |
| A7015 |
Aerosol mask, used with dme nebulizer |
197 |
193 |
$152.48 |
| A4617 |
Mouth piece |
57 |
56 |
$101.36 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
26 |
26 |
$70.87 |
| A4535 |
|
13 |
13 |
$0.00 |