| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6244 |
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
619 |
590 |
$282K |
| A4554 |
Disposable underpads, all sizes |
2,621 |
2,503 |
$255K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
642 |
605 |
$87K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
679 |
634 |
$70K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,149 |
1,126 |
$46K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
361 |
361 |
$32K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
236 |
230 |
$18K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
516 |
484 |
$17K |
| K0003 |
Lightweight wheelchair |
274 |
260 |
$17K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
30 |
29 |
$17K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
121 |
103 |
$14K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
386 |
359 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
1,498 |
1,454 |
$6K |
| A4402 |
Lubricant, per ounce |
589 |
587 |
$5K |
| A6236 |
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$5K |
| E0601 |
Continuous positive airway pressure (cpap) device |
87 |
85 |
$4K |
| A4259 |
Lancets, per box of 100 |
69 |
61 |
$2K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
12 |
12 |
$2K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
67 |
67 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
688 |
676 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
89 |
87 |
$1K |
| E1399 |
Durable medical equipment, miscellaneous |
203 |
198 |
$325.50 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
38 |
38 |
$145.49 |
| A4245 |
Alcohol wipes, per box |
15 |
14 |
$54.91 |