| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
12,354 |
12,247 |
$591K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,431 |
4,387 |
$307K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,792 |
2,771 |
$220K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,897 |
3,834 |
$202K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,318 |
8,117 |
$193K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
778 |
774 |
$119K |
| A4335 |
Incontinence supply; miscellaneous |
4,953 |
4,520 |
$101K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,330 |
4,293 |
$92K |
| A4927 |
Gloves, non-sterile, per 100 |
11,606 |
11,406 |
$70K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,443 |
3,101 |
$50K |
| 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 |
564 |
561 |
$49K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
4,895 |
4,845 |
$43K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
477 |
474 |
$25K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
785 |
779 |
$25K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
756 |
748 |
$23K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
470 |
469 |
$19K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
455 |
412 |
$19K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
398 |
394 |
$18K |
| T4541 |
Incontinence product, disposable underpad, large, each |
400 |
398 |
$10K |
| E1399 |
Durable medical equipment, miscellaneous |
241 |
234 |
$10K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
319 |
316 |
$8K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
517 |
507 |
$7K |
| 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 |
38 |
37 |
$6K |
| E0241 |
Bath tub wall rail, each |
222 |
182 |
$5K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
210 |
207 |
$4K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
86 |
86 |
$4K |
| A4402 |
Lubricant, per ounce |
586 |
388 |
$3K |
| A4670 |
Automatic blood pressure monitor |
138 |
136 |
$3K |
| E0243 |
Toilet rail, each |
136 |
99 |
$3K |
| A4259 |
Lancets, per box of 100 |
457 |
455 |
$3K |
| A4245 |
Alcohol wipes, per box |
516 |
514 |
$834.18 |
| E0244 |
Raised toilet seat |
66 |
65 |
$829.81 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
59 |
58 |
$691.85 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
14 |
14 |
$266.45 |
| E0156 |
Seat attachment, walker |
64 |
64 |
$250.78 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
13 |
13 |
$28.38 |