| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,648 |
1,520 |
$171K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
1,200 |
1,047 |
$167K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,152 |
1,056 |
$141K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,884 |
1,702 |
$135K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,046 |
991 |
$99K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
361 |
343 |
$69K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
700 |
690 |
$47K |
| T4541 |
Incontinence product, disposable underpad, large, each |
966 |
938 |
$41K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
204 |
198 |
$40K |
| K0001 |
Standard wheelchair |
1,400 |
1,372 |
$37K |
| A4927 |
Gloves, non-sterile, per 100 |
923 |
898 |
$33K |
| 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 |
216 |
182 |
$27K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
159 |
150 |
$27K |
| E0601 |
Continuous positive airway pressure (cpap) device |
537 |
529 |
$26K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
354 |
349 |
$10K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
71 |
69 |
$9K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
438 |
431 |
$8K |
| E0570 |
Nebulizer, with compressor |
493 |
491 |
$8K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
26 |
24 |
$7K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
123 |
119 |
$7K |
| B9998 |
Noc for enteral supplies |
114 |
48 |
$6K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
123 |
94 |
$6K |
| A4322 |
Irrigation syringe, bulb or piston, each |
31 |
24 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
130 |
128 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
494 |
484 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
39 |
36 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
57 |
57 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
12 |
12 |
$1K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
33 |
31 |
$1K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
24 |
24 |
$927.74 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
26 |
26 |
$495.11 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
31 |
24 |
$438.73 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
24 |
24 |
$93.26 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
28 |
27 |
$20.77 |