| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
65,859 |
32,910 |
$12.32M |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
65,865 |
32,918 |
$5.15M |
| A4554 |
Disposable underpads, all sizes |
113,018 |
111,901 |
$4.20M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
52,693 |
52,230 |
$3.75M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
55,718 |
55,333 |
$2.68M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
25,165 |
24,937 |
$2.01M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
80,809 |
80,204 |
$1.98M |
| L3410 |
Metatarsal bar wedge, between sole |
33,050 |
16,524 |
$1.83M |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
17,571 |
8,787 |
$1.03M |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
15,405 |
7,698 |
$1.00M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
6,144 |
6,119 |
$891K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
29,456 |
28,785 |
$792K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
15,073 |
14,921 |
$644K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
13,008 |
6,503 |
$629K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
27,739 |
27,588 |
$566K |
| K0001 |
Standard wheelchair |
66,815 |
66,410 |
$564K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
9,750 |
4,873 |
$530K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
15,700 |
15,563 |
$454K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
8,827 |
8,772 |
$394K |
| 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 |
3,918 |
3,887 |
$368K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
11,934 |
11,570 |
$329K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
6,323 |
6,178 |
$327K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
7,285 |
5,429 |
$263K |
| A4927 |
Gloves, non-sterile, per 100 |
58,871 |
57,871 |
$261K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
8,198 |
8,143 |
$257K |
| L3480 |
Heel, pad and depression for spur |
6,292 |
3,143 |
$234K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
3,096 |
3,015 |
$230K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
15,738 |
15,217 |
$224K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
10,214 |
10,137 |
$220K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
11,731 |
6,994 |
$203K |
| A4670 |
Automatic blood pressure monitor |
4,227 |
4,219 |
$190K |
| E1399 |
Durable medical equipment, miscellaneous |
1,024 |
975 |
$174K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
5,929 |
5,875 |
$162K |
| E0241 |
Bath tub wall rail, each |
4,506 |
4,419 |
$137K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
11,417 |
6,982 |
$130K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
14,061 |
13,949 |
$127K |
| 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 |
2,163 |
2,148 |
$126K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,295 |
1,277 |
$122K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
4,218 |
2,106 |
$110K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
305 |
305 |
$107K |
| E0243 |
Toilet rail, each |
1,861 |
1,801 |
$105K |
| A4649 |
Surgical supply; miscellaneous |
601 |
541 |
$104K |
| E0277 |
Powered pressure-reducing air mattress |
826 |
820 |
$104K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
2,518 |
2,490 |
$104K |
| E0271 |
Mattress, innerspring |
3,053 |
3,017 |
$100K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,296 |
1,267 |
$98K |
| E0274 |
Over-bed table |
1,156 |
1,150 |
$98K |
| L3320 |
Lift, elevation, heel and sole, cork, per inch |
1,599 |
1,131 |
$98K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,780 |
1,764 |
$95K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
10,347 |
10,327 |
$89K |
| 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 |
1,261 |
1,252 |
$87K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
7,418 |
7,256 |
$84K |
| E0371 |
Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width |
305 |
305 |
$80K |
| E0156 |
Seat attachment, walker |
9,748 |
9,653 |
$78K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
586 |
576 |
$65K |
| K0003 |
Lightweight wheelchair |
4,504 |
4,480 |
$65K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
5,055 |
5,015 |
$63K |
| B9998 |
Noc for enteral supplies |
691 |
681 |
$58K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
6,865 |
6,749 |
$58K |
| A4335 |
Incontinence supply; miscellaneous |
2,851 |
2,835 |
$58K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
36,449 |
36,224 |
$58K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
684 |
681 |
$57K |
| L3203 |
Orthopedic shoe, oxford with supinator or pronator, junior |
2,234 |
1,117 |
$57K |
| E0244 |
Raised toilet seat |
2,987 |
2,934 |
$53K |
| E2603 |
Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
629 |
624 |
$52K |
| K0006 |
Heavy duty wheelchair |
2,258 |
2,225 |
$51K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
9,242 |
5,809 |
$51K |
| E0570 |
Nebulizer, with compressor |
6,654 |
6,624 |
$44K |
| K0004 |
High strength, lightweight wheelchair |
2,210 |
2,201 |
$37K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
5,261 |
5,219 |
$36K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,386 |
2,370 |
$34K |
| E0315 |
Bed accessory: board, table, or support device, any type |
384 |
384 |
$32K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
77 |
76 |
$30K |
| E0301 |
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, without mattress |
363 |
361 |
$29K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
296 |
274 |
$24K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
3,268 |
3,259 |
$22K |
| E0266 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress |
493 |
491 |
$22K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
180 |
172 |
$21K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
165 |
154 |
$21K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
590 |
558 |
$17K |
| A4402 |
Lubricant, per ounce |
2,194 |
2,163 |
$16K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
700 |
667 |
$15K |
| L1930 |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
97 |
49 |
$14K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
216 |
108 |
$14K |
| E0601 |
Continuous positive airway pressure (cpap) device |
349 |
348 |
$14K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
1,040 |
1,034 |
$12K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
231 |
221 |
$12K |
| E0184 |
Dry pressure mattress |
109 |
107 |
$11K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
668 |
632 |
$9K |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
82 |
82 |
$9K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
128 |
64 |
$9K |
| E0246 |
Transfer tub rail attachment |
266 |
265 |
$9K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,369 |
1,362 |
$8K |
| L2768 |
Orthotic side bar disconnect device, per bar |
96 |
48 |
$7K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
831 |
803 |
$7K |
| K0002 |
Standard hemi (low seat) wheelchair |
389 |
386 |
$7K |
| E0245 |
Tub stool or bench |
312 |
312 |
$6K |
| B4100 |
Food thickener, administered orally, per ounce |
323 |
323 |
$6K |
| K0007 |
Extra heavy duty wheelchair |
203 |
202 |
$6K |
| E0272 |
Mattress, foam rubber |
123 |
122 |
$5K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
86 |
83 |
$4K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
55 |
52 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
320 |
291 |
$4K |
| L3390 |
Outflare wedge |
107 |
63 |
$3K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
32 |
27 |
$3K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
82 |
79 |
$3K |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
152 |
149 |
$3K |
| 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 |
183 |
97 |
$2K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
559 |
556 |
$2K |
| L3150 |
Foot, abduction rotation bar, without shoes |
49 |
49 |
$2K |
| 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 |
191 |
99 |
$2K |
| L2300 |
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable |
14 |
14 |
$2K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
14 |
13 |
$2K |
| K0015 |
Detachable, non-adjustable height armrest, replacement only, each |
26 |
26 |
$1K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
12 |
12 |
$1K |
| E1392 |
Portable oxygen concentrator, rental |
26 |
25 |
$1K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
31 |
25 |
$1K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
161 |
148 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
14 |
14 |
$1K |
| E0305 |
Bed side rails, half length |
14 |
14 |
$906.64 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
131 |
126 |
$812.92 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
37 |
37 |
$672.58 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
15 |
14 |
$501.47 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
51 |
51 |
$363.42 |
| E0215 |
Electric heat pad, moist |
13 |
13 |
$184.99 |
| E0705 |
Transfer device, any type, each |
26 |
26 |
$175.65 |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
15 |
12 |
$131.25 |
| A4452 |
Tape, waterproof, per 18 square inches |
14 |
14 |
$117.93 |
| A4217 |
Sterile water/saline, 500 ml |
12 |
12 |
$116.48 |
| A4245 |
Alcohol wipes, per box |
25 |
24 |
$38.29 |