| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
12,840 |
7,217 |
$3.05M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
4,605 |
3,793 |
$2.55M |
| E1399 |
Durable medical equipment, miscellaneous |
677 |
611 |
$1.29M |
| E0784 |
External ambulatory infusion pump, insulin |
2,780 |
2,525 |
$1.12M |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
14,041 |
10,894 |
$987K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
3,536 |
1,893 |
$721K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
4,301 |
3,691 |
$632K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
777 |
744 |
$369K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
3,567 |
1,878 |
$181K |
| A4259 |
Lancets, per box of 100 |
11,844 |
9,460 |
$156K |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
3,877 |
2,399 |
$123K |
| E0607 |
Home blood glucose monitor |
1,859 |
1,668 |
$107K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
238 |
175 |
$59K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
396 |
378 |
$44K |
| E1140 |
Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
102 |
96 |
$41K |
| A4245 |
Alcohol wipes, per box |
7,326 |
5,764 |
$37K |
| A4258 |
Spring-powered device for lancet, each |
1,778 |
1,610 |
$22K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
305 |
275 |
$16K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
382 |
287 |
$16K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
349 |
315 |
$15K |
| A4256 |
Normal, low and high calibrator solution / chips |
1,734 |
1,566 |
$14K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
275 |
267 |
$10K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
28 |
26 |
$6K |
| K0001 |
Standard wheelchair |
1,016 |
1,000 |
$4K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
308 |
270 |
$3K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
82 |
67 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
181 |
177 |
$787.36 |