| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
59,663 |
57,117 |
$2.03M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
21,562 |
20,510 |
$1.91M |
| A4927 |
Gloves, non-sterile, per 100 |
110,829 |
103,356 |
$1.59M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
18,304 |
17,520 |
$1.47M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
37,637 |
35,976 |
$1.35M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
13,529 |
12,714 |
$1.29M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
9,765 |
9,477 |
$1.07M |
| E1399 |
Durable medical equipment, miscellaneous |
3,773 |
3,560 |
$1.05M |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
4,097 |
3,993 |
$1.01M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,955 |
3,739 |
$857K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
7,981 |
7,806 |
$850K |
| T4541 |
Incontinence product, disposable underpad, large, each |
40,080 |
37,273 |
$766K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
4,561 |
4,383 |
$756K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
7,370 |
7,103 |
$584K |
| A4554 |
Disposable underpads, all sizes |
37,040 |
36,104 |
$553K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,993 |
4,765 |
$518K |
| A4553 |
Non-disposable underpads, all sizes |
12,172 |
11,530 |
$438K |
| B4100 |
Food thickener, administered orally, per ounce |
7,114 |
6,570 |
$330K |
| 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 |
3,120 |
2,809 |
$312K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,846 |
3,719 |
$311K |
| A4500 |
Surgical stockings below knee length, each |
7,643 |
7,304 |
$299K |
| 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 |
2,980 |
2,666 |
$286K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,963 |
1,860 |
$205K |
| 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 |
1,231 |
1,033 |
$185K |
| B9998 |
Noc for enteral supplies |
464 |
415 |
$157K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,929 |
2,568 |
$143K |
| E0570 |
Nebulizer, with compressor |
5,788 |
5,518 |
$131K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
3,689 |
3,630 |
$117K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,007 |
3,909 |
$103K |
| A4670 |
Automatic blood pressure monitor |
1,664 |
1,653 |
$88K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
909 |
896 |
$68K |
| W0137 |
|
293 |
273 |
$61K |
| K0001 |
Standard wheelchair |
3,340 |
3,276 |
$43K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,036 |
1,003 |
$41K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,399 |
1,302 |
$39K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,475 |
1,438 |
$37K |
| A4335 |
Incontinence supply; miscellaneous |
2,606 |
2,402 |
$37K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
611 |
583 |
$28K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,459 |
1,428 |
$26K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,139 |
1,091 |
$16K |
| K0003 |
Lightweight wheelchair |
1,116 |
1,107 |
$15K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,340 |
2,170 |
$15K |
| A7031 |
Face mask interface, replacement for full face mask, each |
439 |
427 |
$11K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
980 |
934 |
$10K |
| E0627 |
Seat lift mechanism, electric, any type |
90 |
88 |
$9K |
| E0601 |
Continuous positive airway pressure (cpap) device |
297 |
293 |
$9K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
83 |
76 |
$8K |
| E0156 |
Seat attachment, walker |
1,359 |
1,336 |
$7K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
894 |
872 |
$7K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
76 |
74 |
$7K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
76 |
73 |
$6K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
250 |
212 |
$5K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
211 |
208 |
$5K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
12 |
12 |
$4K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
130 |
85 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,071 |
1,037 |
$4K |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
146 |
144 |
$4K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
203 |
195 |
$4K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
36 |
36 |
$4K |
| K0006 |
Heavy duty wheelchair |
103 |
102 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
40 |
40 |
$3K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
676 |
663 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
869 |
844 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,184 |
1,099 |
$2K |
| E0244 |
Raised toilet seat |
56 |
53 |
$2K |
| E0277 |
Powered pressure-reducing air mattress |
41 |
39 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,090 |
1,818 |
$2K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
92 |
62 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,715 |
2,476 |
$2K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
325 |
319 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
962 |
912 |
$1K |
| A4259 |
Lancets, per box of 100 |
2,221 |
2,063 |
$1K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
254 |
243 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
155 |
155 |
$1K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,134 |
710 |
$992.04 |
| A5120 |
Skin barrier, wipes or swabs, each |
303 |
278 |
$920.30 |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
15 |
13 |
$899.35 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
343 |
319 |
$857.86 |
| A7037 |
Tubing used with positive airway pressure device |
60 |
56 |
$685.26 |
| 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 |
27 |
27 |
$652.26 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
163 |
156 |
$521.82 |
| A7035 |
Headgear used with positive airway pressure device |
44 |
44 |
$520.76 |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
40 |
39 |
$314.50 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
80 |
79 |
$223.35 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
12 |
12 |
$169.16 |
| 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 |
14 |
14 |
$153.75 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
15 |
15 |
$97.00 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
13 |
13 |
$85.92 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
12 |
12 |
$61.56 |