| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
36,458 |
36,392 |
$1.47M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
34,780 |
34,712 |
$1.40M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14,657 |
14,635 |
$1.05M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12,850 |
12,826 |
$674K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,346 |
3,344 |
$578K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
8,022 |
8,000 |
$553K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
8,354 |
8,342 |
$211K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,192 |
3,188 |
$149K |
| A4927 |
Gloves, non-sterile, per 100 |
28,488 |
28,436 |
$116K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
4,734 |
4,727 |
$110K |
| E1399 |
Durable medical equipment, miscellaneous |
3,710 |
3,704 |
$58K |
| 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 |
580 |
578 |
$56K |
| A4670 |
Automatic blood pressure monitor |
520 |
520 |
$23K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,193 |
1,191 |
$21K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
190 |
155 |
$16K |
| 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 |
81 |
81 |
$15K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
523 |
523 |
$10K |
| K0001 |
Standard wheelchair |
396 |
396 |
$10K |
| A4402 |
Lubricant, per ounce |
1,783 |
1,759 |
$9K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
58 |
38 |
$6K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
89 |
68 |
$5K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
193 |
193 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
65 |
60 |
$4K |
| A4259 |
Lancets, per box of 100 |
512 |
512 |
$3K |
| 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 |
60 |
39 |
$2K |
| A4245 |
Alcohol wipes, per box |
563 |
561 |
$1K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
24 |
24 |
$866.50 |
| A4335 |
Incontinence supply; miscellaneous |
75 |
75 |
$79.62 |