| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
49,209 |
43,506 |
$3.56M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
49,685 |
47,099 |
$2.89M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,777 |
3,534 |
$2.21M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
19,404 |
6,783 |
$1.18M |
| A4927 |
Gloves, non-sterile, per 100 |
64,039 |
54,162 |
$1.10M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
15,186 |
13,933 |
$1.10M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
13,417 |
12,038 |
$1.03M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
14,036 |
12,106 |
$818K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
9,535 |
8,446 |
$815K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
6,651 |
5,816 |
$737K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,105 |
2,843 |
$686K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
41,913 |
39,355 |
$640K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,749 |
7,684 |
$601K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,018 |
957 |
$574K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,647 |
8,713 |
$524K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
2,723 |
2,454 |
$487K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
3,516 |
2,854 |
$426K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
6,145 |
5,661 |
$421K |
| A7030 |
Full face mask used with positive airway pressure device, each |
6,008 |
5,615 |
$397K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,598 |
4,274 |
$396K |
| E0601 |
Continuous positive airway pressure (cpap) device |
15,156 |
14,260 |
$376K |
| E1399 |
Durable medical equipment, miscellaneous |
3,468 |
2,030 |
$359K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
3,336 |
2,820 |
$358K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,120 |
3,739 |
$314K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,306 |
2,239 |
$284K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
3,308 |
1,563 |
$273K |
| A4332 |
Lubricant, individual sterile packet, each |
3,023 |
2,705 |
$225K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,133 |
1,506 |
$218K |
| A4217 |
Sterile water/saline, 500 ml |
3,978 |
3,210 |
$204K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,726 |
11,364 |
$192K |
| A4605 |
Tracheal suction catheter, closed system, each |
2,304 |
2,025 |
$183K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
298 |
247 |
$173K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,434 |
3,183 |
$171K |
| K0001 |
Standard wheelchair |
12,456 |
11,015 |
$164K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
5,610 |
5,083 |
$160K |
| K0004 |
High strength, lightweight wheelchair |
3,425 |
3,238 |
$155K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
4,560 |
1,643 |
$153K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
18,640 |
17,552 |
$139K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,042 |
930 |
$132K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
5,808 |
5,135 |
$131K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
3,263 |
3,056 |
$127K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
2,216 |
2,096 |
$122K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,315 |
2,904 |
$86K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,959 |
4,148 |
$82K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
3,294 |
2,849 |
$82K |
| 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 |
696 |
517 |
$81K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
2,322 |
2,159 |
$75K |
| K0007 |
Extra heavy duty wheelchair |
1,519 |
1,387 |
$70K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
125 |
105 |
$66K |
| A7031 |
Face mask interface, replacement for full face mask, each |
5,569 |
5,034 |
$64K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,605 |
2,440 |
$62K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
608 |
488 |
$60K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
3,124 |
2,841 |
$54K |
| E0570 |
Nebulizer, with compressor |
9,865 |
8,953 |
$50K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
260 |
216 |
$47K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,726 |
4,274 |
$45K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,162 |
1,790 |
$45K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
436 |
321 |
$45K |
| A9270 |
Non-covered item or service |
1,510 |
1,361 |
$42K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
1,545 |
1,398 |
$40K |
| A6210 |
Foam 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 |
190 |
156 |
$39K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
129 |
112 |
$36K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,725 |
1,551 |
$31K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
408 |
364 |
$30K |
| 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 |
731 |
563 |
$30K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
11,226 |
8,205 |
$30K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,710 |
1,562 |
$30K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,058 |
3,427 |
$28K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,194 |
985 |
$28K |
| E0950 |
Wheelchair accessory, tray, each |
16 |
15 |
$26K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
1,149 |
1,058 |
$23K |
| A4618 |
Breathing circuits |
1,868 |
1,691 |
$21K |
| A7035 |
Headgear used with positive airway pressure device |
9,217 |
8,600 |
$18K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,306 |
1,131 |
$18K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,089 |
599 |
$17K |
| A7037 |
Tubing used with positive airway pressure device |
4,575 |
4,372 |
$16K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
244 |
187 |
$16K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
2,237 |
2,111 |
$15K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,734 |
4,164 |
$15K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
80 |
65 |
$13K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,936 |
1,795 |
$12K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
594 |
537 |
$12K |
| A4616 |
Tubing (oxygen), per foot |
1,279 |
1,191 |
$11K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
207 |
187 |
$10K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,610 |
1,407 |
$10K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
15 |
12 |
$10K |
| K0003 |
Lightweight wheelchair |
661 |
547 |
$9K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
140 |
125 |
$9K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
409 |
353 |
$8K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,090 |
1,786 |
$8K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,016 |
864 |
$8K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
12 |
12 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
10,307 |
9,518 |
$6K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
426 |
374 |
$5K |
| A7525 |
Tracheostomy mask, each |
1,276 |
1,152 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,883 |
1,504 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
561 |
462 |
$3K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
908 |
652 |
$3K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
145 |
116 |
$3K |
| A4402 |
Lubricant, per ounce |
870 |
716 |
$3K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
352 |
223 |
$3K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
339 |
266 |
$2K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
105 |
64 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,524 |
2,285 |
$2K |
| E0277 |
Powered pressure-reducing air mattress |
300 |
61 |
$2K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
33 |
27 |
$2K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
57 |
52 |
$840.44 |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
490 |
437 |
$812.30 |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
24 |
12 |
$780.01 |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
81 |
68 |
$779.91 |
| A4615 |
Cannula, nasal |
234 |
207 |
$767.21 |
| A4354 |
Insertion tray with drainage bag but without catheter |
299 |
272 |
$731.53 |
| K0040 |
Adjustable angle footplate, each |
208 |
185 |
$718.04 |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
21 |
18 |
$430.27 |
| A7002 |
Tubing, used with suction pump, each |
934 |
826 |
$389.19 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
83 |
48 |
$189.95 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
111 |
101 |
$122.26 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
17 |
12 |
$84.04 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
238 |
204 |
$78.56 |
| E0156 |
Seat attachment, walker |
120 |
107 |
$75.62 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
77 |
58 |
$51.18 |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
14 |
13 |
$0.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
14 |
12 |
$0.00 |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
18 |
15 |
$0.00 |
| E0325 |
Urinal; male, jug-type, any material |
13 |
12 |
$0.00 |
| S8186 |
Swivel adapter |
15 |
14 |
$0.00 |
| K0005 |
Ultralightweight wheelchair |
15 |
12 |
$0.00 |