| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
42,519 |
42,020 |
$1.99M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
17,901 |
17,725 |
$1.73M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
14,278 |
14,072 |
$1.54M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
29,308 |
29,093 |
$1.04M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
4,489 |
4,480 |
$921K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
10,999 |
10,901 |
$754K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
11,046 |
10,834 |
$331K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
11,363 |
11,245 |
$297K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,705 |
1,688 |
$101K |
| A4927 |
Gloves, non-sterile, per 100 |
26,603 |
26,203 |
$97K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,040 |
1,027 |
$76K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
3,642 |
3,563 |
$58K |
| E1399 |
Durable medical equipment, miscellaneous |
442 |
442 |
$32K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
508 |
252 |
$29K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,007 |
1,007 |
$23K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,375 |
1,365 |
$18K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
76 |
76 |
$17K |
| K0003 |
Lightweight wheelchair |
795 |
795 |
$16K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
354 |
354 |
$10K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
211 |
210 |
$10K |
| A4402 |
Lubricant, per ounce |
2,931 |
2,887 |
$9K |
| E0241 |
Bath tub wall rail, each |
126 |
125 |
$4K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
95 |
95 |
$3K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
85 |
38 |
$3K |
| A4670 |
Automatic blood pressure monitor |
65 |
65 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
217 |
197 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
799 |
799 |
$1K |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$673.83 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
13 |
13 |
$105.75 |