| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,562 |
1,427 |
$207K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,120 |
3,887 |
$158K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,016 |
928 |
$129K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
986 |
846 |
$112K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,531 |
1,471 |
$108K |
| A4927 |
Gloves, non-sterile, per 100 |
2,744 |
2,471 |
$77K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,185 |
2,020 |
$66K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,091 |
1,025 |
$66K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,170 |
2,000 |
$63K |
| 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 |
449 |
373 |
$42K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
751 |
690 |
$42K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,642 |
1,541 |
$38K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
656 |
606 |
$32K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,958 |
1,840 |
$17K |
| K0003 |
Lightweight wheelchair |
660 |
611 |
$15K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,252 |
3,070 |
$14K |
| E0570 |
Nebulizer, with compressor |
185 |
184 |
$10K |
| A7035 |
Headgear used with positive airway pressure device |
594 |
548 |
$8K |
| A4335 |
Incontinence supply; miscellaneous |
2,198 |
1,994 |
$8K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
104 |
98 |
$7K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
168 |
150 |
$6K |
| A7037 |
Tubing used with positive airway pressure device |
414 |
382 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
469 |
425 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
55 |
50 |
$5K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
17 |
13 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
96 |
95 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
33 |
33 |
$2K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
343 |
286 |
$728.27 |
| K0001 |
Standard wheelchair |
102 |
75 |
$161.08 |