| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
37,418 |
37,294 |
$1.08M |
| A4554 |
Disposable underpads, all sizes |
27,627 |
27,527 |
$705K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,881 |
8,836 |
$500K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
5,216 |
5,192 |
$322K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
3,408 |
2,774 |
$301K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
6,287 |
6,257 |
$291K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
6,383 |
6,353 |
$159K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
2,528 |
2,050 |
$150K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,406 |
4,388 |
$125K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
832 |
822 |
$96K |
| 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 |
563 |
560 |
$53K |
| A4927 |
Gloves, non-sterile, per 100 |
10,709 |
10,640 |
$51K |
| A4670 |
Automatic blood pressure monitor |
1,112 |
1,104 |
$48K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
645 |
528 |
$45K |
| 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 |
150 |
147 |
$19K |
| A4402 |
Lubricant, per ounce |
847 |
844 |
$4K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
135 |
135 |
$4K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
146 |
120 |
$4K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
25 |
25 |
$3K |
| E0241 |
Bath tub wall rail, each |
96 |
96 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
359 |
351 |
$3K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
61 |
61 |
$3K |
| A4335 |
Incontinence supply; miscellaneous |
292 |
291 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
12 |
12 |
$432.00 |
| A4259 |
Lancets, per box of 100 |
83 |
82 |
$150.94 |