| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
65,859 |
32,910 |
$12.32M |
| L2275 |
Plastic mod low ext pad/line |
65,865 |
32,918 |
$5.15M |
| A4554 |
Disposable underpads |
113,018 |
111,901 |
$4.20M |
| T4523 |
Adult size brief/diaper lg |
52,693 |
52,230 |
$3.75M |
| T4522 |
Adult size brief/diaper med |
55,718 |
55,333 |
$2.68M |
| T4524 |
Adult size brief/diaper xl |
25,165 |
24,937 |
$2.01M |
| T4535 |
Disposable liner/shield/pad |
80,809 |
80,204 |
$1.98M |
| L3410 |
Shoe metatarsal bar between |
33,050 |
16,524 |
$1.83M |
| L3216 |
Orthoped ladies shoes dpth i |
17,571 |
8,787 |
$1.03M |
| L3221 |
Orthopedic mens shoes dpth i |
15,405 |
7,698 |
$1.00M |
| T4543 |
Adult disp brief/diap abv xl |
6,144 |
6,119 |
$891K |
| T4537 |
Reusable underpad bed size |
29,456 |
28,785 |
$792K |
| E1390 |
Oxygen concentrator |
15,073 |
14,921 |
$644K |
| L3215 |
Orthopedic ftwear ladies oxf |
13,008 |
6,503 |
$629K |
| E0261 |
Hosp bed semi-electr w/o mat |
27,739 |
27,588 |
$566K |
| K0001 |
Standard wheelchair |
66,815 |
66,410 |
$564K |
| L3219 |
Orthopedic mens shoes oxford |
9,750 |
4,873 |
$530K |
| E0143 |
Walker folding wheeled w/o s |
15,700 |
15,563 |
$454K |
| T4521 |
Adult size brief/diaper sm |
8,827 |
8,772 |
$394K |
| B4154 |
Ef spec metabolic noninherit |
3,918 |
3,887 |
$368K |
| T4539 |
Reuse diaper/brief any size |
11,934 |
11,570 |
$329K |
| E2611 |
Gen use back cush wdth <22in |
6,323 |
6,178 |
$327K |
| E0990 |
Wheelchair elevating leg res |
7,285 |
5,429 |
$263K |
| A4927 |
Non-sterile gloves |
58,871 |
57,871 |
$261K |
| E0240 |
Bath/shower chair |
8,198 |
8,143 |
$257K |
| L3480 |
Shoe heel pad & depress for |
6,292 |
3,143 |
$234K |
| E0247 |
Trans bench w/wo comm open |
3,096 |
3,015 |
$230K |
| T4540 |
Reusable underpad chair size |
15,738 |
15,217 |
$224K |
| E0630 |
Patient lift hydraulic |
10,214 |
10,137 |
$220K |
| E0973 |
W/ch access det adj armrest |
11,731 |
6,994 |
$203K |
| A4670 |
Automatic bp monitor, dial |
4,227 |
4,219 |
$190K |
| E1399 |
Durable medical equipment mi |
1,024 |
975 |
$174K |
| E0163 |
Commode chair with fixed arm |
5,929 |
5,875 |
$162K |
| E0241 |
Bath tub wall rail |
4,506 |
4,419 |
$137K |
| E0971 |
Wheelchair anti-tipping devi |
11,417 |
6,982 |
$130K |
| E0431 |
Portable gaseous 02 |
14,061 |
13,949 |
$127K |
| B4150 |
Ef complet w/intact nutrient |
2,163 |
2,148 |
$126K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,295 |
1,277 |
$122K |
| L3202 |
Oxford w/ supinat/pronator c |
4,218 |
2,106 |
$110K |
| A9276 |
Disposable sensor, cgm sys |
305 |
305 |
$107K |
| E0243 |
Toilet rail |
1,861 |
1,801 |
$105K |
| A4649 |
Surgical supplies |
601 |
541 |
$104K |
| E0277 |
Powered pres-redu air mattrs |
826 |
820 |
$104K |
| E0185 |
Gel pressure mattress pad |
2,518 |
2,490 |
$104K |
| E0271 |
Mattress innerspring |
3,053 |
3,017 |
$100K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,296 |
1,267 |
$98K |
| E0274 |
Over-bed table |
1,156 |
1,150 |
$98K |
| L3320 |
Shoe lift elev heel/sole cor |
1,599 |
1,131 |
$98K |
| A4239 |
Non-adju cgm supply allow |
1,780 |
1,764 |
$95K |
| E1038 |
Transport chair pt wt<=300lb |
10,347 |
10,327 |
$89K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,261 |
1,252 |
$87K |
| E2601 |
Gen w/c cushion wdth < 22 in |
7,418 |
7,256 |
$84K |
| E0371 |
Nonpower mattress overlay |
305 |
305 |
$80K |
| E0156 |
Walker seat attachment |
9,748 |
9,653 |
$78K |
| E1226 |
Manual fully reclining back |
586 |
576 |
$65K |
| K0003 |
Lightweight wheelchair |
4,504 |
4,480 |
$65K |
| E0260 |
Hosp bed semi-electr w/ matt |
5,055 |
5,015 |
$63K |
| B9998 |
Enteral supp not otherwise c |
691 |
681 |
$58K |
| E0978 |
W/c acc,saf belt pelv strap |
6,865 |
6,749 |
$58K |
| A4335 |
Incontinence supply |
2,851 |
2,835 |
$58K |
| K0195 |
Elevating whlchair leg rests |
36,449 |
36,224 |
$58K |
| K0553 |
Ther cgm supply allowance |
684 |
681 |
$57K |
| L3203 |
Oxford w/ supinator/pronator |
2,234 |
1,117 |
$57K |
| E0244 |
Toilet seat raised |
2,987 |
2,934 |
$53K |
| E2603 |
Skin protect wc cus wd <22in |
629 |
624 |
$52K |
| K0006 |
Heavy duty wheelchair |
2,258 |
2,225 |
$51K |
| E0961 |
Wheelchair brake extension |
9,242 |
5,809 |
$51K |
| E0570 |
Nebulizer with compression |
6,654 |
6,624 |
$44K |
| K0004 |
High strength ltwt whlchr |
2,210 |
2,201 |
$37K |
| E0955 |
Cushioned headrest |
5,261 |
5,219 |
$36K |
| E0149 |
Heavy duty wheeled walker |
2,386 |
2,370 |
$34K |
| E0315 |
Bed accessory brd/tbl/supprt |
384 |
384 |
$32K |
| A6540 |
Gc stocking waistlngth 30-40 |
77 |
76 |
$30K |
| E0301 |
Hd hosp bed, 350-600 lbs |
363 |
361 |
$29K |
| T4530 |
Ped size brief/diaper lg |
296 |
274 |
$24K |
| E0100 |
Cane adjust/fixed with tip |
3,268 |
3,259 |
$22K |
| E0266 |
Hosp bed total elec w/o matt |
493 |
491 |
$22K |
| A6212 |
Foam drg <=16 sq in w/border |
180 |
172 |
$21K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
165 |
154 |
$21K |
| A4216 |
Sterile water/saline, 10 ml |
590 |
558 |
$17K |
| A4402 |
Lubricant per ounce |
2,194 |
2,163 |
$16K |
| A6402 |
Sterile gauze <= 16 sq in |
700 |
667 |
$15K |
| L1930 |
Afo plastic |
97 |
49 |
$14K |
| L3217 |
Ladies shoes hightop depth i |
216 |
108 |
$14K |
| E0601 |
Cont airway pressure device |
349 |
348 |
$14K |
| E0105 |
Cane adjust/fixed quad/3 pro |
1,040 |
1,034 |
$12K |
| E2103 |
Non-adju cgm receiver/mon |
231 |
221 |
$12K |
| E0184 |
Dry pressure mattress |
109 |
107 |
$11K |
| A6216 |
Non-sterile gauze<=16 sq in |
668 |
632 |
$9K |
| K0052 |
Swingaway detach ftrest repl |
82 |
82 |
$9K |
| L3222 |
Mens shoes hightop depth inl |
128 |
64 |
$9K |
| E0246 |
Transfer tub rail attachment |
266 |
265 |
$9K |
| E0181 |
Press pad alternating w/ pum |
1,369 |
1,362 |
$8K |
| L2768 |
Ortho sidebar disconnect |
96 |
48 |
$7K |
| A7005 |
Nondisposable nebulizer set |
831 |
803 |
$7K |
| K0002 |
Stnd hemi (low seat) whlchr |
389 |
386 |
$7K |
| E0245 |
Tub stool or bench |
312 |
312 |
$6K |
| B4100 |
Food thickener oral |
323 |
323 |
$6K |
| K0007 |
Extra heavy duty wheelchair |
203 |
202 |
$6K |
| E0272 |
Mattress foam rubber |
123 |
122 |
$5K |
| B4155 |
Ef incomplete/modular |
86 |
83 |
$4K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
55 |
52 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
320 |
291 |
$4K |
| L3390 |
Shoe outflare wedge |
107 |
63 |
$3K |
| A6197 |
Alginate drsg >16 <=48 sq in |
32 |
27 |
$3K |
| A6258 |
Transparent film >16<=48 in |
82 |
79 |
$3K |
| E0621 |
Patient lift sling or seat |
152 |
149 |
$3K |
| A5512 |
Multi den insert direct form |
183 |
97 |
$2K |
| E0910 |
Trapeze bar attached to bed |
559 |
556 |
$2K |
| L3150 |
Abduct rotation bar w/o shoe |
49 |
49 |
$2K |
| A5500 |
Diab shoe for density insert |
191 |
99 |
$2K |
| L2300 |
Abduction bar jointed adjust |
14 |
14 |
$2K |
| E2622 |
Adj skin pro w/c cus wd<22in |
14 |
13 |
$2K |
| K0015 |
Detach non-adj ht armrst rep |
26 |
26 |
$1K |
| E0265 |
Hosp bed total electr w/ mat |
12 |
12 |
$1K |
| E1392 |
Portable oxygen concentrator |
26 |
25 |
$1K |
| L1820 |
Ko elas w/ condyle pads & jo |
31 |
25 |
$1K |
| A6446 |
Conform band s w>=3" <5"/yd |
161 |
148 |
$1K |
| A4357 |
Bedside drainage bag |
14 |
14 |
$1K |
| E0305 |
Rails bed side half length |
14 |
14 |
$906.64 |
| A4450 |
Non-waterproof tape |
131 |
126 |
$812.92 |
| E0165 |
Commode chair with detacharm |
37 |
37 |
$672.58 |
| L3908 |
Who cock-up nonmolde pre ots |
15 |
14 |
$501.47 |
| A6250 |
Skin seal protect moisturizr |
51 |
51 |
$363.42 |
| E0215 |
Electric heat pad moist |
13 |
13 |
$184.99 |
| E0705 |
Transfer device |
26 |
26 |
$175.65 |
| A6403 |
Sterile gauze>16 <= 48 sq in |
15 |
12 |
$131.25 |
| A4452 |
Waterproof tape |
14 |
14 |
$117.93 |
| A4217 |
Sterile water/saline, 500 ml |
12 |
12 |
$116.48 |
| A4245 |
Alcohol wipes per box |
25 |
24 |
$38.29 |