| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
10,864 |
10,692 |
$1.53M |
| A4554 |
Disposable underpads, all sizes |
35,258 |
34,717 |
$1.32M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
8,008 |
7,942 |
$989K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,216 |
4,176 |
$692K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
13,759 |
13,434 |
$579K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,981 |
1,963 |
$284K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,147 |
2,128 |
$246K |
| A4335 |
Incontinence supply; miscellaneous |
40,424 |
39,755 |
$229K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,972 |
1,902 |
$208K |
| 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 |
521 |
489 |
$111K |
| E1399 |
Durable medical equipment, miscellaneous |
130 |
118 |
$83K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
765 |
669 |
$83K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
425 |
413 |
$80K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
4,243 |
4,097 |
$70K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
635 |
580 |
$56K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,024 |
2,016 |
$43K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
85 |
83 |
$40K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
401 |
360 |
$35K |
| K0001 |
Standard wheelchair |
2,561 |
2,553 |
$31K |
| 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 |
39 |
39 |
$21K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
115 |
103 |
$20K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
593 |
587 |
$13K |
| A4259 |
Lancets, per box of 100 |
3,516 |
3,459 |
$13K |
| E0570 |
Nebulizer, with compressor |
746 |
741 |
$8K |
| K0003 |
Lightweight wheelchair |
531 |
531 |
$7K |
| A4245 |
Alcohol wipes, per box |
2,604 |
2,564 |
$4K |
| A4670 |
Automatic blood pressure monitor |
40 |
38 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
25 |
25 |
$538.76 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
15 |
14 |
$291.02 |