| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
1,925 |
1,711 |
$159K |
| L0630 |
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), 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, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,079 |
1,028 |
$73K |
| A4554 |
Disposable underpads, all sizes |
1,041 |
932 |
$46K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
624 |
483 |
$17K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
217 |
214 |
$12K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
235 |
172 |
$7K |
| K0003 |
Lightweight wheelchair |
135 |
129 |
$5K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
1,749 |
1,656 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
361 |
250 |
$572.48 |
| A4259 |
Lancets, per box of 100 |
425 |
314 |
$359.98 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
16 |
12 |
$310.14 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
17 |
12 |
$262.88 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
87 |
63 |
$211.80 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
15 |
12 |
$118.98 |
| 0011A |
|
23 |
23 |
$0.00 |
| 0012A |
|
30 |
28 |
$0.00 |