| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
1,888 |
1,873 |
$158K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,505 |
1,343 |
$95K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
660 |
597 |
$58K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,476 |
1,329 |
$51K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
351 |
307 |
$37K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
708 |
707 |
$31K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,713 |
1,713 |
$30K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
492 |
123 |
$21K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
102 |
90 |
$9K |
| L0635 |
Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment |
12 |
12 |
$6K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
561 |
560 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,742 |
1,728 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,862 |
1,861 |
$3K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
1,451 |
1,445 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
45 |
26 |
$1K |
| 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 |
45 |
26 |
$937.84 |
| A4335 |
Incontinence supply; miscellaneous |
59 |
52 |
$894.78 |