| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
22,695 |
22,335 |
$758K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,505 |
5,397 |
$636K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,510 |
5,428 |
$576K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
2,809 |
2,734 |
$494K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
11,449 |
10,950 |
$436K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,294 |
2,246 |
$392K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,967 |
2,875 |
$312K |
| E0570 |
Nebulizer, with compressor |
1,454 |
1,442 |
$172K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,232 |
1,201 |
$165K |
| A4335 |
Incontinence supply; miscellaneous |
27,183 |
26,903 |
$149K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
767 |
737 |
$68K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
645 |
625 |
$58K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
426 |
210 |
$57K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
484 |
467 |
$49K |
| K0001 |
Standard wheelchair |
2,086 |
2,039 |
$37K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
657 |
630 |
$24K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
223 |
223 |
$22K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
239 |
117 |
$21K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,200 |
2,153 |
$15K |
| A7002 |
Tubing, used with suction pump, each |
1,421 |
1,406 |
$5K |
| A4259 |
Lancets, per box of 100 |
459 |
451 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
137 |
137 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,411 |
1,397 |
$2K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
636 |
416 |
$2K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
1,266 |
1,254 |
$2K |
| A4245 |
Alcohol wipes, per box |
665 |
648 |
$1K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
1,241 |
1,227 |
$1K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
225 |
166 |
$307.76 |