| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
9,237 |
9,224 |
$350K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,463 |
3,459 |
$279K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,328 |
9,321 |
$273K |
| E1392 |
Portable oxygen concentrator, rental |
1,296 |
1,296 |
$251K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,543 |
2,539 |
$223K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,503 |
2,495 |
$154K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
4,548 |
4,546 |
$105K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,857 |
2,853 |
$78K |
| 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 |
524 |
513 |
$59K |
| K0003 |
Lightweight wheelchair |
324 |
322 |
$50K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
327 |
326 |
$22K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
47 |
47 |
$21K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
165 |
163 |
$20K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
64 |
62 |
$17K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
191 |
191 |
$13K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
314 |
312 |
$10K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
98 |
64 |
$9K |
| E0156 |
Seat attachment, walker |
477 |
472 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
889 |
872 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
1,832 |
1,815 |
$5K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
276 |
270 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
513 |
506 |
$5K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
79 |
55 |
$5K |
| L3410 |
Metatarsal bar wedge, between sole |
84 |
52 |
$4K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
96 |
93 |
$4K |
| E0974 |
Manual wheelchair accessory, anti-rollback device, each |
54 |
53 |
$4K |
| E0241 |
Bath tub wall rail, each |
76 |
73 |
$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 |
26 |
26 |
$3K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
191 |
191 |
$3K |
| A4456 |
Adhesive remover, wipes, any type, each |
279 |
276 |
$3K |
| L3340 |
Heel wedge, sach |
86 |
52 |
$3K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
61 |
61 |
$3K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
12 |
12 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
21 |
15 |
$3K |
| L3390 |
Outflare wedge |
87 |
52 |
$2K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
161 |
161 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
24 |
24 |
$2K |
| 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 |
43 |
27 |
$2K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
21 |
16 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
54 |
54 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
41 |
41 |
$2K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
18 |
13 |
$1K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
12 |
12 |
$1K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
13 |
13 |
$994.83 |
| 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 |
44 |
26 |
$872.40 |
| E0246 |
Transfer tub rail attachment |
15 |
14 |
$687.74 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
202 |
202 |
$325.94 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
12 |
12 |
$118.53 |
| A4322 |
Irrigation syringe, bulb or piston, each |
27 |
24 |
$104.38 |
| A4371 |
Ostomy skin barrier, powder, per oz |
12 |
12 |
$53.22 |