| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
1,405 |
785 |
$119K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
799 |
707 |
$87K |
| A4554 |
Disposable underpads, all sizes |
2,960 |
2,708 |
$87K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
910 |
793 |
$80K |
| K0001 |
Standard wheelchair |
1,019 |
942 |
$72K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
410 |
368 |
$59K |
| E0601 |
Continuous positive airway pressure (cpap) device |
377 |
332 |
$48K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
315 |
280 |
$45K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
733 |
670 |
$32K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
284 |
274 |
$30K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
518 |
457 |
$28K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
825 |
750 |
$25K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,082 |
986 |
$23K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,047 |
879 |
$19K |
| 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 |
216 |
208 |
$18K |
| A4335 |
Incontinence supply; miscellaneous |
3,831 |
3,406 |
$11K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,508 |
1,320 |
$10K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
262 |
255 |
$9K |
| E0570 |
Nebulizer, with compressor |
209 |
190 |
$8K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
95 |
90 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
1,307 |
1,146 |
$8K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
496 |
447 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,019 |
944 |
$5K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
116 |
104 |
$5K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
15 |
14 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
153 |
150 |
$5K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
91 |
81 |
$4K |
| A4217 |
Sterile water/saline, 500 ml |
653 |
540 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
12 |
12 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
63 |
63 |
$2K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
82 |
74 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
101 |
90 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
230 |
174 |
$2K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
15 |
13 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
300 |
289 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
17 |
14 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
78 |
69 |
$1K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
200 |
184 |
$996.69 |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
26 |
25 |
$902.19 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
13 |
12 |
$877.18 |
| A4402 |
Lubricant, per ounce |
207 |
198 |
$801.22 |
| A4371 |
Ostomy skin barrier, powder, per oz |
234 |
227 |
$774.66 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
65 |
61 |
$774.36 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
13 |
13 |
$721.53 |
| A5112 |
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each |
29 |
26 |
$678.88 |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
16 |
16 |
$581.45 |
| E0155 |
Wheel attachment, rigid pick-up walker, per pair |
29 |
28 |
$194.43 |
| A4245 |
Alcohol wipes, per box |
103 |
83 |
$124.15 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
35 |
24 |
$49.89 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
35 |
24 |
$17.93 |
| A7015 |
Aerosol mask, used with dme nebulizer |
18 |
12 |
$15.17 |
| E0156 |
Seat attachment, walker |
25 |
25 |
$0.00 |