| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4930 |
Gloves, sterile, per pair |
8,295 |
6,203 |
$1.28M |
| A4554 |
Disposable underpads, all sizes |
10,719 |
8,722 |
$601K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,676 |
2,196 |
$505K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,757 |
2,320 |
$456K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
11,702 |
8,854 |
$350K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,624 |
1,403 |
$317K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,481 |
2,876 |
$254K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
428 |
421 |
$157K |
| A4927 |
Gloves, non-sterile, per 100 |
4,445 |
3,619 |
$122K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,719 |
1,472 |
$70K |
| K0001 |
Standard wheelchair |
1,840 |
1,456 |
$68K |
| E0245 |
Tub stool or bench |
1,068 |
972 |
$50K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
903 |
643 |
$41K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
396 |
369 |
$41K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,090 |
1,490 |
$13K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
49 |
48 |
$12K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
173 |
150 |
$9K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
457 |
391 |
$9K |
| A4670 |
Automatic blood pressure monitor |
78 |
37 |
$5K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
342 |
270 |
$4K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 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 |
32 |
24 |
$2K |
| K0003 |
Lightweight wheelchair |
71 |
38 |
$2K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
30 |
24 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
636 |
469 |
$1K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
15 |
12 |
$1K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
82 |
64 |
$796.59 |
| E0156 |
Seat attachment, walker |
81 |
53 |
$652.97 |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
58 |
39 |
$194.80 |
| A4245 |
Alcohol wipes, per box |
25 |
14 |
$169.15 |
| A7000 |
Canister, disposable, used with suction pump, each |
15 |
12 |
$0.53 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
64 |
64 |
$0.00 |