| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,025 |
2,605 |
$326K |
| A4554 |
Disposable underpads, all sizes |
5,798 |
5,015 |
$251K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,818 |
2,636 |
$200K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,078 |
1,886 |
$179K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,649 |
1,563 |
$163K |
| 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 |
2,012 |
1,622 |
$152K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,258 |
1,504 |
$113K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,428 |
2,768 |
$111K |
| E0570 |
Nebulizer, with compressor |
3,011 |
1,902 |
$55K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,005 |
2,072 |
$44K |
| A7037 |
Tubing used with positive airway pressure device |
2,668 |
1,760 |
$27K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
166 |
148 |
$22K |
| A4927 |
Gloves, non-sterile, per 100 |
1,051 |
978 |
$20K |
| A7035 |
Headgear used with positive airway pressure device |
1,635 |
1,100 |
$18K |
| A4670 |
Automatic blood pressure monitor |
185 |
152 |
$8K |
| T2025 |
Waiver services; not otherwise specified (nos) |
191 |
186 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,558 |
2,333 |
$8K |
| K0001 |
Standard wheelchair |
802 |
481 |
$7K |
| A4335 |
Incontinence supply; miscellaneous |
394 |
376 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
54 |
36 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
110 |
88 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
78 |
25 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
39 |
24 |
$547.77 |
| A7015 |
Aerosol mask, used with dme nebulizer |
25 |
19 |
$24.54 |