| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Ther cgm supply allowance |
5,025 |
4,753 |
$1.67M |
| E1390 |
Oxygen concentrator |
52,103 |
50,146 |
$715K |
| A4239 |
Non-adju cgm supply allow |
1,831 |
1,796 |
$567K |
| T4541 |
Large disposable underpad |
75,043 |
72,870 |
$337K |
| E0471 |
Rad w/backup non inv intrfc |
1,940 |
1,930 |
$240K |
| E0601 |
Cont airway pressure device |
38,580 |
38,346 |
$235K |
| E0277 |
Powered pres-redu air mattrs |
4,441 |
4,325 |
$223K |
| T4526 |
Adult size pull-on med |
33,994 |
33,288 |
$209K |
| E0470 |
Rad w/o backup non-inv intfc |
7,578 |
7,532 |
$195K |
| K0001 |
Standard wheelchair |
34,583 |
34,199 |
$188K |
| T4527 |
Adult size pull-on lg |
23,102 |
22,554 |
$170K |
| T4523 |
Adult size brief/diaper lg |
13,567 |
13,255 |
$162K |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,299 |
1,228 |
$149K |
| A4670 |
Automatic bp monitor, dial |
9,415 |
7,862 |
$148K |
| T4535 |
Disposable liner/shield/pad |
29,233 |
27,683 |
$133K |
| E0562 |
Humidifier heated used w pap |
54,303 |
53,952 |
$133K |
| E0431 |
Portable gaseous 02 |
50,970 |
48,604 |
$126K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
11,056 |
9,954 |
$119K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,776 |
2,338 |
$109K |
| E0295 |
Hosp bed semi-elect w/o matt |
10,607 |
10,568 |
$101K |
| B4154 |
Ef spec metabolic noninherit |
1,534 |
1,481 |
$94K |
| E0143 |
Walker folding wheeled w/o s |
9,517 |
9,356 |
$85K |
| E0570 |
Nebulizer with compression |
7,581 |
7,472 |
$83K |
| A7034 |
Nasal application device |
9,821 |
9,723 |
$77K |
| E1399 |
Durable medical equipment mi |
507 |
433 |
$74K |
| T4524 |
Adult size brief/diaper xl |
9,051 |
8,806 |
$70K |
| T4522 |
Adult size brief/diaper med |
11,146 |
10,880 |
$66K |
| B4150 |
Ef complet w/intact nutrient |
6,562 |
5,745 |
$64K |
| K0823 |
Pwc gp 2 std cap chair |
608 |
602 |
$64K |
| A7030 |
Cpap full face mask |
2,546 |
2,519 |
$55K |
| K0006 |
Heavy duty wheelchair |
4,913 |
4,906 |
$54K |
| E0303 |
Hosp bed hvy dty xtra wide |
883 |
875 |
$48K |
| K0003 |
Lightweight wheelchair |
5,866 |
5,811 |
$43K |
| K0007 |
Extra heavy duty wheelchair |
2,157 |
2,133 |
$42K |
| A7035 |
Pos airway press headgear |
12,495 |
12,394 |
$38K |
| T4528 |
Adult size pull-on xl |
12,987 |
12,622 |
$38K |
| B4035 |
Enteral feed supp pump per d |
3,249 |
3,080 |
$36K |
| E0245 |
Tub stool or bench |
6,655 |
6,605 |
$36K |
| T4525 |
Adult size pull-on sm |
6,989 |
6,807 |
$34K |
| A4604 |
Tubing with heating element |
4,310 |
4,292 |
$33K |
| E0600 |
Suction pump portab hom modl |
3,275 |
3,231 |
$31K |
| E0630 |
Patient lift hydraulic |
3,770 |
3,707 |
$29K |
| K0554 |
Ther cgm receiver/monitor |
162 |
162 |
$28K |
| E0163 |
Commode chair with fixed arm |
3,669 |
3,635 |
$28K |
| E0247 |
Trans bench w/wo comm open |
2,663 |
2,640 |
$27K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,426 |
1,388 |
$23K |
| E2402 |
Neg press wound therapy pump |
3,511 |
3,436 |
$22K |
| K0195 |
Elevating whlchair leg rests |
10,913 |
10,715 |
$22K |
| K0108 |
W/c component-accessory nos |
2,600 |
1,132 |
$20K |
| E0156 |
Walker seat attachment |
5,707 |
5,639 |
$19K |
| B9002 |
Enter nutr inf pump any type |
2,893 |
2,859 |
$18K |
| A4385 |
Ost skn barrier sld ext wear |
1,792 |
1,718 |
$18K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,301 |
3,881 |
$17K |
| A4351 |
Straight tip urine catheter |
3,709 |
3,443 |
$17K |
| A4663 |
Dialysis blood pressure cuff |
1,435 |
1,408 |
$16K |
| A7037 |
Pos airway pressure tubing |
8,020 |
7,941 |
$16K |
| K0738 |
Portable gas oxygen system |
4,213 |
4,107 |
$15K |
| E0305 |
Rails bed side half length |
8,164 |
8,064 |
$15K |
| E0272 |
Mattress foam rubber |
7,344 |
7,279 |
$14K |
| A7032 |
Replacement nasal cushion |
2,008 |
1,979 |
$14K |
| T4534 |
Youth size pull-on |
3,950 |
3,783 |
$14K |
| E0603 |
Electric breast pump |
8,818 |
8,776 |
$12K |
| E1038 |
Transport chair pt wt<=300lb |
2,855 |
2,836 |
$11K |
| A4322 |
Irrigation syringe |
1,363 |
1,315 |
$11K |
| A4349 |
Disposable male external cat |
1,976 |
1,813 |
$11K |
| K0800 |
Pov group 1 std up to 300lbs |
65 |
65 |
$11K |
| E1226 |
Manual fully reclining back |
1,475 |
1,452 |
$10K |
| E0465 |
Home vent invasive interface |
94 |
72 |
$9K |
| A5061 |
Pouch drainable w barrier at |
387 |
358 |
$9K |
| A7038 |
Pos airway pressure filter |
9,081 |
8,953 |
$8K |
| E0271 |
Mattress innerspring |
2,174 |
2,141 |
$8K |
| A6212 |
Foam drg <=16 sq in w/border |
1,581 |
1,472 |
$8K |
| E0149 |
Heavy duty wheeled walker |
595 |
589 |
$8K |
| T4530 |
Ped size brief/diaper lg |
4,856 |
4,727 |
$7K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,415 |
1,373 |
$7K |
| A7033 |
Replacement nasal pillows |
2,059 |
2,019 |
$6K |
| A4425 |
Ost pch drain for barrier fl |
1,685 |
1,630 |
$6K |
| E0973 |
W/ch access det adj armrest |
468 |
284 |
$6K |
| A7046 |
Repl water chamber, pap dev |
2,868 |
2,842 |
$6K |
| E0310 |
Rails bed side full length |
3,239 |
3,201 |
$5K |
| B4155 |
Ef incomplete/modular |
256 |
239 |
$5K |
| E0971 |
Wheelchair anti-tipping devi |
4,016 |
3,227 |
$5K |
| E0100 |
Cane adjust/fixed with tip |
2,118 |
2,108 |
$5K |
| E1028 |
W/c manual swingaway |
489 |
364 |
$4K |
| A4927 |
Non-sterile gloves |
6,421 |
6,114 |
$4K |
| A7031 |
Replacement facemask interfa |
598 |
594 |
$4K |
| A4357 |
Bedside drainage bag |
3,284 |
3,170 |
$4K |
| A6250 |
Skin seal protect moisturizr |
9,673 |
9,486 |
$4K |
| T4521 |
Adult size brief/diaper sm |
1,816 |
1,774 |
$4K |
| A5056 |
1 pc ost pouch w filter |
220 |
210 |
$4K |
| E0265 |
Hosp bed total electr w/ mat |
34 |
24 |
$4K |
| A7000 |
Disposable canister for pump |
2,075 |
1,765 |
$3K |
| E0297 |
Hosp bed total elect w/o mat |
71 |
66 |
$3K |
| A4624 |
Tracheal suction tube |
274 |
262 |
$3K |
| E0651 |
Pneum compressor segmental |
1,447 |
1,446 |
$3K |
| E2361 |
22nf sealed leadacid battery |
68 |
64 |
$3K |
| A4407 |
Ext wear ost skn barr <=4sq" |
202 |
200 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
1,135 |
1,118 |
$3K |
| E0181 |
Press pad alternating w/ pum |
1,235 |
1,226 |
$2K |
| T4536 |
Reusable pull-on any size |
327 |
319 |
$2K |
| A7039 |
Filter, non disposable w pap |
2,846 |
2,821 |
$2K |
| E0720 |
Tens two lead |
918 |
913 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
6,634 |
6,020 |
$2K |
| T4537 |
Reusable underpad bed size |
1,271 |
1,256 |
$2K |
| K0004 |
High strength ltwt whlchr |
161 |
161 |
$2K |
| E1392 |
Portable oxygen concentrator |
544 |
544 |
$2K |
| B4158 |
Ef ped complete intact nut |
12 |
12 |
$2K |
| A6197 |
Alginate drsg >16 <=48 sq in |
976 |
945 |
$2K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,302 |
2,102 |
$2K |
| E0776 |
Iv pole |
1,298 |
1,284 |
$2K |
| E1031 |
Rollabout chair with casters |
199 |
199 |
$2K |
| A4456 |
Adhesive remover, wipes |
2,561 |
2,449 |
$2K |
| E0244 |
Toilet seat raised |
474 |
471 |
$2K |
| E1161 |
Manual adult wc w tiltinspac |
25 |
25 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
2,550 |
2,443 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
392 |
387 |
$2K |
| A4362 |
Solid skin barrier |
110 |
106 |
$2K |
| A4628 |
Oropharyngeal suction cath |
759 |
729 |
$1K |
| A7526 |
Tracheostomy tube collar |
317 |
294 |
$1K |
| E0105 |
Cane adjust/fixed quad/3 pro |
163 |
161 |
$1K |
| A5120 |
Skin barrier, wipe or swab |
3,394 |
3,274 |
$1K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
199 |
195 |
$903.64 |
| A9901 |
Delivery/set up/dispensing |
20 |
12 |
$886.90 |
| B9998 |
Enteral supp not otherwise c |
2,476 |
2,081 |
$846.21 |
| E0165 |
Commode chair with detacharm |
91 |
91 |
$773.83 |
| K0821 |
Pwc gp 2 std port cap chair |
19 |
19 |
$768.93 |
| A4623 |
Tracheostomy inner cannula |
93 |
88 |
$676.32 |
| A7002 |
Tubing used w suction pump |
738 |
715 |
$675.25 |
| E2365 |
U1 sealed leadacid battery |
27 |
27 |
$667.89 |
| A7004 |
Disposable nebulizer sml vol |
5,159 |
5,046 |
$651.38 |
| E0240 |
Bath/shower chair |
65 |
65 |
$615.45 |
| E0621 |
Patient lift sling or seat |
909 |
900 |
$579.13 |
| A4388 |
Drainable pch w ex wear barr |
558 |
536 |
$486.77 |
| T4532 |
Ped size pull-on lg |
244 |
233 |
$434.34 |
| E0955 |
Cushioned headrest |
36 |
36 |
$355.65 |
| A4406 |
Pectin based ostomy paste |
477 |
467 |
$354.54 |
| B4088 |
Gastro/jejuno tube, low-pro |
405 |
396 |
$337.81 |
| A4402 |
Lubricant per ounce |
1,522 |
1,464 |
$316.98 |
| E0246 |
Transfer tub rail attachment |
58 |
57 |
$296.64 |
| A4394 |
Ostomy pouch liq deodorant |
502 |
491 |
$265.94 |
| E0961 |
Wheelchair brake extension |
474 |
308 |
$262.68 |
| A4338 |
Indwelling catheter latex |
401 |
388 |
$259.90 |
| A4371 |
Skin barrier powder per oz |
815 |
784 |
$213.41 |
| E0241 |
Bath tub wall rail |
30 |
25 |
$201.10 |
| T4533 |
Youth size brief/diaper |
13 |
12 |
$190.45 |
| E0910 |
Trapeze bar attached to bed |
144 |
144 |
$169.53 |
| A4310 |
Insert tray w/o bag/cath |
309 |
291 |
$144.73 |
| T4531 |
Ped size pull-on sm/med |
200 |
196 |
$144.51 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
903 |
856 |
$134.13 |
| A4335 |
Incontinence supply |
6,209 |
6,029 |
$117.27 |
| A7015 |
Aerosol mask used w nebulize |
397 |
387 |
$113.99 |
| E0114 |
Crutch underarm pair no wood |
97 |
97 |
$104.09 |
| K0733 |
12-24hr sealed lead acid |
14 |
14 |
$90.47 |
| A4331 |
Extension drainage tubing |
225 |
215 |
$65.06 |
| E1356 |
Batt pack/cart, port conc |
745 |
686 |
$65.00 |
| A4615 |
Cannula nasal |
4,601 |
4,262 |
$64.82 |
| E2313 |
Pwc harness, expand control |
26 |
25 |
$56.52 |
| A4450 |
Non-waterproof tape |
486 |
467 |
$49.09 |
| A7520 |
Trach/laryn tube non-cuffed |
12 |
12 |
$45.50 |
| A6549 |
Grad com garm noc day use |
1,029 |
1,019 |
$44.75 |
| A4556 |
Electrodes, pair |
68 |
68 |
$40.22 |
| E0604 |
Hosp grade elec breast pump |
1,224 |
1,224 |
$38.08 |
| A4367 |
Ostomy belt |
105 |
103 |
$35.68 |
| A6454 |
Self-adher band w>=3" <5"/yd |
568 |
560 |
$34.34 |
| A6260 |
Wound cleanser any type/size |
429 |
420 |
$31.19 |
| A4424 |
Ost pch drain w bar & filter |
14 |
12 |
$22.07 |
| B4034 |
Enter feed supkit syr by day |
69 |
65 |
$19.02 |
| E0441 |
Stationary o2 contents, gas |
17 |
13 |
$15.09 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
125 |
122 |
$5.30 |
| A6216 |
Non-sterile gauze<=16 sq in |
132 |
106 |
$2.00 |
| A5500 |
Diab shoe for density insert |
295 |
294 |
$0.00 |
| A5513 |
Multi den insert custom mold |
178 |
177 |
$0.00 |
| A5512 |
Multi den insert direct form |
57 |
57 |
$0.00 |
| B4036 |
Enteral feed sup kit grav by |
12 |
12 |
$0.00 |
| A6258 |
Transparent film >16<=48 in |
16 |
16 |
$0.00 |
| A6240 |
Hydrocolld drg filler paste |
682 |
648 |
$0.00 |
| A6550 |
Neg pres wound ther drsg set |
259 |
167 |
$0.00 |
| E2311 |
Electro connect btw 2 sys |
12 |
12 |
$0.00 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
13 |
12 |
$0.00 |