| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
49,209 |
43,506 |
$3.56M |
| E1390 |
Oxygen concentrator |
49,685 |
47,099 |
$2.89M |
| E0465 |
Home vent invasive interface |
3,777 |
3,534 |
$2.21M |
| E0445 |
Oximeter non-invasive |
19,404 |
6,783 |
$1.18M |
| A4927 |
Non-sterile gloves |
64,039 |
54,162 |
$1.10M |
| T4534 |
Youth size pull-on |
15,186 |
13,933 |
$1.10M |
| T4522 |
Adult size brief/diaper med |
13,417 |
12,038 |
$1.03M |
| T4530 |
Ped size brief/diaper lg |
14,036 |
12,106 |
$818K |
| T4523 |
Adult size brief/diaper lg |
9,535 |
8,446 |
$815K |
| A4351 |
Straight tip urine catheter |
6,651 |
5,816 |
$737K |
| T4543 |
Adult disp brief/diap abv xl |
3,105 |
2,843 |
$686K |
| E0431 |
Portable gaseous 02 |
41,913 |
39,355 |
$640K |
| T4527 |
Adult size pull-on lg |
8,749 |
7,684 |
$601K |
| E0466 |
Home vent non-invasive inter |
1,018 |
957 |
$574K |
| T4526 |
Adult size pull-on med |
9,647 |
8,713 |
$524K |
| E0471 |
Rad w/backup non inv intrfc |
2,723 |
2,454 |
$487K |
| A4483 |
Moisture exchanger |
3,516 |
2,854 |
$426K |
| T4521 |
Adult size brief/diaper sm |
6,145 |
5,661 |
$421K |
| A7030 |
Cpap full face mask |
6,008 |
5,615 |
$397K |
| T4528 |
Adult size pull-on xl |
4,598 |
4,274 |
$396K |
| E0601 |
Cont airway pressure device |
15,156 |
14,260 |
$376K |
| E1399 |
Durable medical equipment mi |
3,468 |
2,030 |
$359K |
| A4216 |
Sterile water/saline, 10 ml |
3,336 |
2,820 |
$358K |
| T4524 |
Adult size brief/diaper xl |
4,120 |
3,739 |
$314K |
| E0603 |
Electric breast pump |
2,306 |
2,239 |
$284K |
| E0202 |
Phototherapy light w/ photom |
3,308 |
1,563 |
$273K |
| A4332 |
Lube sterile packet |
3,023 |
2,705 |
$225K |
| A6212 |
Foam drg <=16 sq in w/border |
2,133 |
1,506 |
$218K |
| A4217 |
Sterile water/saline, 500 ml |
3,978 |
3,210 |
$204K |
| T4535 |
Disposable liner/shield/pad |
12,726 |
11,364 |
$192K |
| A4605 |
Trach suction cath close sys |
2,304 |
2,025 |
$183K |
| E0955 |
Cushioned headrest |
298 |
247 |
$173K |
| T4525 |
Adult size pull-on sm |
3,434 |
3,183 |
$171K |
| K0001 |
Standard wheelchair |
12,456 |
11,015 |
$164K |
| E0600 |
Suction pump portab hom modl |
5,610 |
5,083 |
$160K |
| K0004 |
High strength ltwt whlchr |
3,425 |
3,238 |
$155K |
| K0108 |
W/c component-accessory nos |
4,560 |
1,643 |
$153K |
| E0562 |
Humidifier heated used w pap |
18,640 |
17,552 |
$139K |
| E0482 |
Cough stimulating device |
1,042 |
930 |
$132K |
| E0443 |
Portable 02 contents, gas |
5,808 |
5,135 |
$131K |
| A7034 |
Nasal application device |
3,263 |
3,056 |
$127K |
| E0470 |
Rad w/o backup non-inv intfc |
2,216 |
2,096 |
$122K |
| A7526 |
Tracheostomy tube collar |
3,315 |
2,904 |
$86K |
| E0260 |
Hosp bed semi-electr w/ matt |
4,959 |
4,148 |
$82K |
| A4624 |
Tracheal suction tube |
3,294 |
2,849 |
$82K |
| A6197 |
Alginate drsg >16 <=48 sq in |
696 |
517 |
$81K |
| E0424 |
Stationary compressed gas 02 |
2,322 |
2,159 |
$75K |
| K0007 |
Extra heavy duty wheelchair |
1,519 |
1,387 |
$70K |
| E0240 |
Bath/shower chair |
125 |
105 |
$66K |
| A7031 |
Replacement facemask interfa |
5,569 |
5,034 |
$64K |
| A7005 |
Nondisposable nebulizer set |
2,605 |
2,440 |
$62K |
| E0971 |
Wheelchair anti-tipping devi |
608 |
488 |
$60K |
| E0143 |
Walker folding wheeled w/o s |
3,124 |
2,841 |
$54K |
| E0570 |
Nebulizer with compression |
9,865 |
8,953 |
$50K |
| E0973 |
W/ch access det adj armrest |
260 |
216 |
$47K |
| A4604 |
Tubing with heating element |
4,726 |
4,274 |
$45K |
| A4452 |
Waterproof tape |
2,162 |
1,790 |
$45K |
| A6021 |
Collagen dressing <=16 sq in |
436 |
321 |
$45K |
| A9270 |
Non-covered item or service |
1,510 |
1,361 |
$42K |
| T4529 |
Ped size brief/diaper sm/med |
1,545 |
1,398 |
$40K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
190 |
156 |
$39K |
| A4352 |
Coude tip urinary catheter |
129 |
112 |
$36K |
| A7032 |
Replacement nasal cushion |
1,725 |
1,551 |
$31K |
| A4213 |
20+ cc syringe only |
408 |
364 |
$30K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
731 |
563 |
$30K |
| A4520 |
Incontinence garment anytype |
11,226 |
8,205 |
$30K |
| A7520 |
Trach/laryn tube non-cuffed |
1,710 |
1,562 |
$30K |
| A6402 |
Sterile gauze <= 16 sq in |
4,058 |
3,427 |
$28K |
| E0630 |
Patient lift hydraulic |
1,194 |
985 |
$28K |
| E0950 |
Tray |
16 |
15 |
$26K |
| T4531 |
Ped size pull-on sm/med |
1,149 |
1,058 |
$23K |
| A4618 |
Breathing circuits |
1,868 |
1,691 |
$21K |
| A7035 |
Pos airway press headgear |
9,217 |
8,600 |
$18K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,306 |
1,131 |
$18K |
| E1028 |
W/c manual swingaway |
1,089 |
599 |
$17K |
| A7037 |
Pos airway pressure tubing |
4,575 |
4,372 |
$16K |
| A4349 |
Disposable male external cat |
244 |
187 |
$16K |
| E0990 |
Wheelchair elevating leg res |
2,237 |
2,111 |
$15K |
| A7000 |
Disposable canister for pump |
4,734 |
4,164 |
$15K |
| K0823 |
Pwc gp 2 std cap chair |
80 |
65 |
$13K |
| A4628 |
Oropharyngeal suction cath |
1,936 |
1,795 |
$12K |
| E0978 |
W/c acc,saf belt pelv strap |
594 |
537 |
$12K |
| A4616 |
Tubing (oxygen) per foot |
1,279 |
1,191 |
$11K |
| E0960 |
W/c shoulder harness/straps |
207 |
187 |
$10K |
| E0181 |
Press pad alternating w/ pum |
1,610 |
1,407 |
$10K |
| E0951 |
Loop heel |
15 |
12 |
$10K |
| K0003 |
Lightweight wheelchair |
661 |
547 |
$9K |
| A4247 |
Betadine/iodine swabs/wipes |
140 |
125 |
$9K |
| A7033 |
Replacement nasal pillows |
409 |
353 |
$8K |
| A4357 |
Bedside drainage bag |
2,090 |
1,786 |
$8K |
| A7521 |
Trach/laryn tube cuffed |
1,016 |
864 |
$8K |
| E0956 |
W/c lateral trunk/hip suppor |
12 |
12 |
$6K |
| A7038 |
Pos airway pressure filter |
10,307 |
9,518 |
$6K |
| A4606 |
Oxygen probe used w oximeter |
426 |
374 |
$5K |
| A7525 |
Tracheostomy mask |
1,276 |
1,152 |
$4K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,883 |
1,504 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
561 |
462 |
$3K |
| A6446 |
Conform band s w>=3" <5"/yd |
908 |
652 |
$3K |
| A4338 |
Indwelling catheter latex |
145 |
116 |
$3K |
| A4402 |
Lubricant per ounce |
870 |
716 |
$3K |
| A9999 |
Dme supply or accessory, nos |
352 |
223 |
$3K |
| A4358 |
Urinary leg or abdomen bag |
339 |
266 |
$2K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
105 |
64 |
$2K |
| A7046 |
Repl water chamber, pap dev |
2,524 |
2,285 |
$2K |
| E0277 |
Powered pres-redu air mattrs |
300 |
61 |
$2K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
33 |
27 |
$2K |
| E2607 |
Skin pro/pos wc cus wd <22in |
57 |
52 |
$840.44 |
| A7018 |
Water distilled w/nebulizer |
490 |
437 |
$812.30 |
| A6530 |
Compression stocking bk18-30 |
24 |
12 |
$780.01 |
| A6266 |
Impreg gauze no h20/sal/yard |
81 |
68 |
$779.91 |
| A4615 |
Cannula nasal |
234 |
207 |
$767.21 |
| A4354 |
Cath insertion tray w/bag |
299 |
272 |
$731.53 |
| K0040 |
Adjustable angle footplate |
208 |
185 |
$718.04 |
| E0250 |
Hosp bed fixed ht w/ mattres |
21 |
18 |
$430.27 |
| A7002 |
Tubing used w suction pump |
934 |
826 |
$389.19 |
| A4314 |
Cath w/drainage 2-way latex |
83 |
48 |
$189.95 |
| K0195 |
Elevating whlchair leg rests |
111 |
101 |
$122.26 |
| A6457 |
Tubular dressing |
17 |
12 |
$84.04 |
| A7039 |
Filter, non disposable w pap |
238 |
204 |
$78.56 |
| E0156 |
Walker seat attachment |
120 |
107 |
$75.62 |
| A6449 |
Lt compres band >=3" <5"/yd |
77 |
58 |
$51.18 |
| E2219 |
Foam caster tire any size ea |
14 |
13 |
$0.00 |
| A4450 |
Non-waterproof tape |
14 |
12 |
$0.00 |
| E2213 |
Pneumatic prop tire insert |
18 |
15 |
$0.00 |
| E0325 |
Urinal male jug-type |
13 |
12 |
$0.00 |
| S8186 |
Swivel adaptor |
15 |
14 |
$0.00 |
| K0005 |
Ultralightweight wheelchair |
15 |
12 |
$0.00 |