| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Special med equip, noswaiver |
68,529 |
31,714 |
$3.43M |
| S5165 |
Home modifications per serv |
35,390 |
9,478 |
$3.16M |
| J2426 |
Inj, invega sustenna, 1 mg |
712 |
560 |
$2.24M |
| E0260 |
Hosp bed semi-electr w/ matt |
5,280 |
3,997 |
$1.81M |
| E1090 |
Wheelchair lightweight det a |
3,380 |
3,092 |
$1.54M |
| E1390 |
Oxygen concentrator |
25,829 |
19,226 |
$1.15M |
| E0627 |
Seat lift mech, electric any |
6,779 |
5,278 |
$1.08M |
| E0635 |
Patient lift electric |
2,486 |
1,909 |
$972K |
| J0401 |
Inj, abilify maintena, 1 mg |
437 |
352 |
$970K |
| B4150 |
Ef complet w/intact nutrient |
7,583 |
5,255 |
$648K |
| E0601 |
Cont airway pressure device |
12,246 |
10,388 |
$492K |
| E0303 |
Hosp bed hvy dty xtra wide |
454 |
363 |
$394K |
| E0247 |
Trans bench w/wo comm open |
4,696 |
3,657 |
$321K |
| E0973 |
W/ch access det adj armrest |
4,226 |
2,194 |
$317K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,926 |
1,826 |
$309K |
| E1290 |
Wheelchair hvy duty detach a |
842 |
775 |
$291K |
| E1260 |
Wheelchair lightwt foot rest |
2,671 |
2,471 |
$275K |
| B4154 |
Ef spec metabolic noninherit |
800 |
520 |
$255K |
| E0240 |
Bath/shower chair |
609 |
318 |
$250K |
| A4239 |
Non-adju cgm supply allow |
1,065 |
828 |
$245K |
| L7364 |
Twelve volt battery utah/equ |
554 |
315 |
$240K |
| E0470 |
Rad w/o backup non-inv intfc |
3,054 |
2,558 |
$231K |
| E2611 |
Gen use back cush wdth <22in |
2,014 |
1,470 |
$220K |
| E0185 |
Gel pressure mattress pad |
2,765 |
2,122 |
$218K |
| E2603 |
Skin protect wc cus wd <22in |
1,878 |
1,356 |
$168K |
| E1240 |
Whchr litwt det arm leg rest |
1,050 |
971 |
$156K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
853 |
619 |
$156K |
| E0570 |
Nebulizer with compression |
9,426 |
7,738 |
$148K |
| E0562 |
Humidifier heated used w pap |
5,849 |
4,910 |
$130K |
| E0971 |
Wheelchair anti-tipping devi |
3,538 |
1,752 |
$123K |
| E0294 |
Hosp bed semi-elect w/ mattr |
4,823 |
3,918 |
$114K |
| L7366 |
Battery chrgr 12 volt utah/e |
387 |
253 |
$113K |
| E1250 |
Wheelchair lightwt fixed arm |
1,212 |
1,120 |
$110K |
| E0431 |
Portable gaseous 02 |
13,133 |
10,418 |
$108K |
| B4035 |
Enteral feed supp pump per d |
695 |
480 |
$103K |
| E0135 |
Walker folding adjust/fixed |
4,522 |
3,566 |
$101K |
| A7030 |
Cpap full face mask |
1,791 |
1,445 |
$100K |
| E0244 |
Toilet seat raised |
1,889 |
1,444 |
$96K |
| E0149 |
Heavy duty wheeled walker |
2,804 |
2,169 |
$90K |
| A4604 |
Tubing with heating element |
3,721 |
3,089 |
$89K |
| E1399 |
Durable medical equipment mi |
70 |
49 |
$78K |
| E2366 |
Battery charger, single mode |
603 |
389 |
$73K |
| E0443 |
Portable 02 contents, gas |
2,614 |
1,907 |
$67K |
| E0159 |
Brake for wheeled walker |
5,043 |
3,768 |
$60K |
| E0165 |
Commode chair with detacharm |
1,752 |
1,340 |
$60K |
| E0305 |
Rails bed side half length |
5,203 |
4,308 |
$50K |
| A7031 |
Replacement facemask interfa |
2,437 |
2,058 |
$50K |
| E0155 |
Walker wheel attachment,pair |
4,072 |
3,390 |
$50K |
| E0156 |
Walker seat attachment |
5,339 |
4,153 |
$43K |
| E1392 |
Portable oxygen concentrator |
2,571 |
1,859 |
$42K |
| E0265 |
Hosp bed total electr w/ mat |
31 |
27 |
$42K |
| A7034 |
Nasal application device |
1,065 |
870 |
$41K |
| E0163 |
Commode chair with fixed arm |
1,402 |
1,091 |
$39K |
| A7035 |
Pos airway press headgear |
3,251 |
2,665 |
$38K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,813 |
2,996 |
$36K |
| E0961 |
Wheelchair brake extension |
2,380 |
1,196 |
$35K |
| E0990 |
Wheelchair elevating leg res |
1,202 |
1,005 |
$35K |
| E0951 |
Loop heel |
2,691 |
1,345 |
$33K |
| E0241 |
Bath tub wall rail |
1,194 |
813 |
$30K |
| E1038 |
Transport chair pt wt<=300lb |
795 |
638 |
$30K |
| E0630 |
Patient lift hydraulic |
161 |
130 |
$29K |
| E0143 |
Walker folding wheeled w/o s |
1,317 |
1,043 |
$28K |
| A5500 |
Diab shoe for density insert |
812 |
350 |
$25K |
| E0105 |
Cane adjust/fixed quad/3 pro |
771 |
629 |
$24K |
| A4670 |
Automatic bp monitor, dial |
533 |
464 |
$23K |
| T4527 |
Adult size pull-on lg |
193 |
145 |
$23K |
| B4034 |
Enter feed supkit syr by day |
260 |
175 |
$20K |
| B9002 |
Enter nutr inf pump any type |
376 |
269 |
$20K |
| A7038 |
Pos airway pressure filter |
6,401 |
5,305 |
$17K |
| E0912 |
Hd trapeze bar free standing |
412 |
325 |
$16K |
| E0248 |
Hdtrans bench w/wo comm open |
139 |
121 |
$16K |
| K0003 |
Lightweight wheelchair |
4,749 |
4,157 |
$15K |
| E0295 |
Hosp bed semi-elect w/o matt |
161 |
136 |
$15K |
| A7032 |
Replacement nasal cushion |
691 |
577 |
$15K |
| T4528 |
Adult size pull-on xl |
141 |
98 |
$15K |
| T4526 |
Adult size pull-on med |
143 |
104 |
$14K |
| K0738 |
Portable gas oxygen system |
1,193 |
854 |
$11K |
| B4102 |
Ef adult fluids and electro |
18 |
12 |
$10K |
| E2612 |
Gen use back cush wdth>=22in |
35 |
29 |
$9K |
| A7005 |
Nondisposable nebulizer set |
775 |
642 |
$9K |
| A7046 |
Repl water chamber, pap dev |
1,428 |
1,161 |
$8K |
| T4543 |
Adult disp brief/diap abv xl |
75 |
55 |
$7K |
| E2604 |
Skin protect wc cus wd>=22in |
34 |
29 |
$7K |
| T4537 |
Reusable underpad bed size |
219 |
145 |
$6K |
| A4253 |
Blood glucose/reagent strips |
2,667 |
1,638 |
$6K |
| A6402 |
Sterile gauze <= 16 sq in |
437 |
320 |
$5K |
| E0271 |
Mattress innerspring |
110 |
87 |
$4K |
| 99211 |
|
297 |
287 |
$4K |
| A5514 |
Mult den insert dir carv/cam |
78 |
38 |
$4K |
| T4541 |
Large disposable underpad |
220 |
150 |
$4K |
| A7003 |
Nebulizer administration set |
2,525 |
2,088 |
$4K |
| A4927 |
Non-sterile gloves |
293 |
189 |
$3K |
| E0600 |
Suction pump portab hom modl |
60 |
52 |
$3K |
| T4535 |
Disposable liner/shield/pad |
186 |
127 |
$3K |
| A6250 |
Skin seal protect moisturizr |
197 |
121 |
$3K |
| E2607 |
Skin pro/pos wc cus wd <22in |
24 |
12 |
$3K |
| L3908 |
Who cock-up nonmolde pre ots |
55 |
38 |
$3K |
| A7033 |
Replacement nasal pillows |
145 |
126 |
$2K |
| E0168 |
Heavyduty/wide commode chair |
46 |
40 |
$2K |
| A9279 |
Monitoring feature/devicenoc |
3,280 |
2,759 |
$2K |
| E1020 |
Residual limb support system |
100 |
74 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
63 |
51 |
$2K |
| E0910 |
Trapeze bar attached to bed |
159 |
140 |
$2K |
| E0272 |
Mattress foam rubber |
18 |
13 |
$1K |
| K0195 |
Elevating whlchair leg rests |
378 |
255 |
$1K |
| E0705 |
Transfer device |
32 |
27 |
$1K |
| J7613 |
Albuterol non-comp unit |
736 |
423 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
50 |
37 |
$1K |
| 99213 |
|
14 |
13 |
$878.02 |
| E0243 |
Toilet rail |
16 |
12 |
$790.00 |
| A4357 |
Bedside drainage bag |
206 |
154 |
$737.23 |
| A5120 |
Skin barrier, wipe or swab |
101 |
76 |
$433.54 |
| T4542 |
Small disposable underpad |
20 |
14 |
$427.70 |
| A7015 |
Aerosol mask used w nebulize |
408 |
338 |
$305.11 |
| A7002 |
Tubing used w suction pump |
17 |
12 |
$214.35 |
| A4259 |
Lancets per box |
872 |
631 |
$189.87 |
| E0441 |
Stationary o2 contents, gas |
143 |
135 |
$143.40 |
| J7620 |
Albuterol ipratrop non-comp |
40 |
24 |
$82.50 |
| E0607 |
Blood glucose monitor home |
28 |
18 |
$37.62 |
| Q0513 |
Disp fee inhal drugs/30 days |
1,145 |
749 |
$25.87 |
| K0006 |
Heavy duty wheelchair |
43 |
37 |
$0.00 |
| A9270 |
Non-covered item or service |
217 |
171 |
$0.00 |
| G0008 |
Admin influenza virus vac |
48 |
48 |
$0.00 |
| 90674 |
|
17 |
17 |
$0.00 |