| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4335 |
Incontinence supply; miscellaneous |
1,611 |
1,598 |
$112K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,298 |
2,255 |
$81K |
| T4541 |
Incontinence product, disposable underpad, large, each |
897 |
884 |
$51K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,090 |
2,008 |
$48K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
397 |
390 |
$42K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
417 |
414 |
$34K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,363 |
1,340 |
$28K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
1,517 |
1,487 |
$26K |
| A4930 |
Gloves, sterile, per pair |
174 |
166 |
$13K |
| E0570 |
Nebulizer, with compressor |
138 |
138 |
$13K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
335 |
334 |
$7K |
| A6447 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard |
137 |
137 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
117 |
117 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
236 |
224 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
277 |
276 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
195 |
191 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
68 |
63 |
$726.83 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
74 |
72 |
$702.89 |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$467.73 |
| A7031 |
Face mask interface, replacement for full face mask, each |
15 |
14 |
$390.29 |
| A7035 |
Headgear used with positive airway pressure device |
26 |
25 |
$389.20 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
98 |
93 |
$310.88 |
| A7015 |
Aerosol mask, used with dme nebulizer |
125 |
121 |
$245.04 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
12 |
12 |
$10.35 |