| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
13,125 |
12,783 |
$906K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
5,369 |
5,263 |
$658K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,367 |
3,285 |
$431K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,182 |
4,088 |
$404K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
9,303 |
8,994 |
$266K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,607 |
5,481 |
$197K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,121 |
1,112 |
$106K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
4,661 |
4,548 |
$68K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
213 |
211 |
$63K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
904 |
463 |
$55K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
694 |
641 |
$52K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,123 |
1,092 |
$30K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
534 |
275 |
$25K |
| K0001 |
Standard wheelchair |
1,534 |
1,530 |
$17K |
| A4927 |
Gloves, non-sterile, per 100 |
2,519 |
2,446 |
$11K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
255 |
255 |
$8K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
140 |
70 |
$7K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
12 |
12 |
$7K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
210 |
210 |
$6K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
627 |
626 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
112 |
111 |
$3K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
72 |
72 |
$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 |
36 |
24 |
$2K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
329 |
328 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
789 |
789 |
$1K |
| E0570 |
Nebulizer, with compressor |
24 |
24 |
$345.76 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
222 |
222 |
$319.12 |
| K0003 |
Lightweight wheelchair |
13 |
13 |
$117.56 |