| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,197 |
1,179 |
$143K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,330 |
1,280 |
$105K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
727 |
706 |
$94K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
350 |
346 |
$47K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,158 |
1,125 |
$27K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
108 |
106 |
$13K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
69 |
67 |
$10K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
52 |
52 |
$6K |
| E0570 |
Nebulizer, with compressor |
158 |
154 |
$6K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
25 |
25 |
$4K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
242 |
118 |
$2K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
27 |
24 |
$1K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
41 |
37 |
$384.46 |
| A4927 |
Gloves, non-sterile, per 100 |
12 |
12 |
$380.85 |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
28 |
24 |
$358.96 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
25 |
25 |
$81.05 |