| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4245 |
Alcohol wipes, per box |
5,627 |
5,586 |
$107K |
| A4554 |
Disposable underpads, all sizes |
2,650 |
2,619 |
$107K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,080 |
2,066 |
$105K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,351 |
1,329 |
$97K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,636 |
1,608 |
$90K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
977 |
967 |
$84K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,371 |
1,362 |
$65K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,288 |
1,277 |
$41K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
447 |
310 |
$22K |
| A4927 |
Gloves, non-sterile, per 100 |
3,292 |
3,253 |
$19K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,700 |
1,673 |
$13K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
264 |
259 |
$13K |
| K0001 |
Standard wheelchair |
1,790 |
926 |
$10K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
438 |
264 |
$5K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
420 |
300 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12 |
12 |
$698.86 |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
64 |
64 |
$568.00 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
25 |
24 |
$142.24 |
| E0570 |
Nebulizer, with compressor |
92 |
20 |
$120.58 |