| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
22,785 |
21,625 |
$818K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,963 |
3,799 |
$812K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
16,222 |
15,531 |
$720K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
10,061 |
9,514 |
$698K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,950 |
8,504 |
$607K |
| A4927 |
Gloves, non-sterile, per 100 |
31,535 |
30,031 |
$446K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
6,309 |
6,004 |
$432K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,128 |
1,883 |
$430K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,358 |
2,174 |
$234K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,798 |
1,684 |
$124K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,688 |
1,567 |
$86K |
| A4670 |
Automatic blood pressure monitor |
1,419 |
1,372 |
$50K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
937 |
346 |
$31K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
146 |
138 |
$14K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
167 |
160 |
$12K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
245 |
236 |
$12K |
| 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 |
71 |
66 |
$8K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
44 |
41 |
$7K |
| E0245 |
Tub stool or bench |
196 |
184 |
$6K |
| 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 |
124 |
99 |
$4K |
| 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 |
128 |
99 |
$4K |
| K0001 |
Standard wheelchair |
144 |
138 |
$3K |
| E0570 |
Nebulizer, with compressor |
29 |
27 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
56 |
55 |
$2K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
28 |
28 |
$1K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
16 |
12 |
$548.52 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
228 |
112 |
$365.22 |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
12 |
12 |
$227.99 |
| A7015 |
Aerosol mask, used with dme nebulizer |
42 |
13 |
$51.30 |
| E0627 |
Seat lift mechanism, electric, any type |
13 |
13 |
$0.00 |