| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
172,141 |
169,841 |
$9.45M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
70,707 |
69,804 |
$6.57M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
59,079 |
58,357 |
$4.14M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
37,381 |
36,866 |
$3.67M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
101,280 |
99,721 |
$3.12M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
13,139 |
12,906 |
$2.48M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
43,888 |
43,322 |
$1.25M |
| 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 |
7,944 |
7,825 |
$997K |
| E1399 |
Durable medical equipment, miscellaneous |
6,615 |
5,999 |
$807K |
| A4649 |
Surgical supply; miscellaneous |
11,909 |
11,005 |
$790K |
| 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 |
8,785 |
8,652 |
$671K |
| A4927 |
Gloves, non-sterile, per 100 |
159,139 |
156,663 |
$659K |
| E0570 |
Nebulizer, with compressor |
5,428 |
5,402 |
$472K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
9,718 |
9,582 |
$471K |
| 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 |
4,982 |
4,920 |
$442K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
8,351 |
8,225 |
$376K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
5,630 |
5,568 |
$340K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,055 |
3,910 |
$310K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,568 |
4,508 |
$268K |
| B9998 |
Noc for enteral supplies |
2,087 |
1,997 |
$247K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,950 |
1,923 |
$160K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
259 |
255 |
$149K |
| K0001 |
Standard wheelchair |
505 |
499 |
$136K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
727 |
669 |
$128K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,485 |
3,301 |
$120K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
4,363 |
4,306 |
$113K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
12,882 |
12,512 |
$104K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,830 |
1,770 |
$98K |
| E0241 |
Bath tub wall rail, each |
1,913 |
1,871 |
$97K |
| A9270 |
Non-covered item or service |
1,876 |
1,851 |
$85K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
668 |
655 |
$84K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
3,517 |
3,474 |
$84K |
| E0371 |
Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width |
116 |
115 |
$77K |
| A4670 |
Automatic blood pressure monitor |
2,063 |
2,055 |
$74K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,035 |
1,004 |
$70K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,010 |
1,934 |
$67K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,155 |
2,144 |
$66K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
669 |
618 |
$65K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,861 |
4,589 |
$58K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
716 |
643 |
$57K |
| E2603 |
Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
461 |
457 |
$51K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
1,181 |
1,155 |
$50K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
3,291 |
3,243 |
$48K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
944 |
896 |
$48K |
| A4335 |
Incontinence supply; miscellaneous |
3,368 |
3,284 |
$46K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
382 |
347 |
$46K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,429 |
1,392 |
$46K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
778 |
770 |
$42K |
| B4100 |
Food thickener, administered orally, per ounce |
1,760 |
1,724 |
$38K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
290 |
281 |
$34K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,681 |
1,524 |
$33K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,492 |
1,452 |
$32K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
71 |
65 |
$28K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,538 |
2,365 |
$26K |
| E0156 |
Seat attachment, walker |
1,492 |
1,479 |
$25K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
174 |
151 |
$22K |
| A4217 |
Sterile water/saline, 500 ml |
2,449 |
2,400 |
$18K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
138 |
138 |
$16K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,471 |
1,444 |
$16K |
| A4259 |
Lancets, per box of 100 |
3,016 |
2,992 |
$14K |
| A4245 |
Alcohol wipes, per box |
5,108 |
5,062 |
$14K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
192 |
190 |
$13K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
228 |
226 |
$11K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,045 |
998 |
$10K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
134 |
132 |
$10K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,469 |
1,435 |
$10K |
| E0244 |
Raised toilet seat |
496 |
494 |
$9K |
| A4402 |
Lubricant, per ounce |
1,275 |
1,264 |
$8K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
376 |
363 |
$6K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
387 |
387 |
$6K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
107 |
103 |
$5K |
| A4322 |
Irrigation syringe, bulb or piston, each |
177 |
166 |
$4K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
216 |
205 |
$4K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
98 |
98 |
$4K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
211 |
201 |
$4K |
| E0315 |
Bed accessory: board, table, or support device, any type |
52 |
52 |
$3K |
| E0184 |
Dry pressure mattress |
40 |
40 |
$3K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
97 |
95 |
$2K |
| E0274 |
Over-bed table |
41 |
41 |
$2K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
25 |
25 |
$2K |
| E0215 |
Electric heat pad, moist |
59 |
59 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
13 |
13 |
$1K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
13 |
13 |
$742.98 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
30 |
27 |
$726.88 |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
14 |
13 |
$620.58 |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
15 |
15 |
$355.57 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
12 |
12 |
$234.78 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
12 |
12 |
$207.65 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$170.88 |
| A4246 |
Betadine or phisohex solution, per pint |
37 |
37 |
$91.90 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
16 |
13 |
$88.58 |