| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
5,216 |
5,160 |
$416K |
| A4554 |
Disposable underpads, all sizes |
9,875 |
9,757 |
$378K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,517 |
3,477 |
$301K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,393 |
4,349 |
$278K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
846 |
845 |
$146K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,359 |
4,329 |
$118K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,437 |
1,406 |
$45K |
| K0003 |
Lightweight wheelchair |
2,088 |
2,064 |
$41K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
645 |
645 |
$41K |
| A4670 |
Automatic blood pressure monitor |
532 |
514 |
$23K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
159 |
159 |
$21K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
651 |
641 |
$21K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
388 |
383 |
$15K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
236 |
123 |
$14K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
309 |
266 |
$14K |
| K0001 |
Standard wheelchair |
710 |
710 |
$13K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
47 |
24 |
$12K |
| 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 |
434 |
252 |
$11K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
457 |
442 |
$10K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
115 |
61 |
$9K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
597 |
597 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
2,159 |
2,095 |
$8K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
422 |
244 |
$8K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
226 |
222 |
$6K |
| E0601 |
Continuous positive airway pressure (cpap) device |
152 |
150 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,006 |
2,993 |
$5K |
| A4402 |
Lubricant, per ounce |
1,158 |
1,126 |
$5K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
206 |
122 |
$4K |
| E0156 |
Seat attachment, walker |
350 |
345 |
$4K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
54 |
54 |
$3K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
30 |
13 |
$2K |
| E0244 |
Raised toilet seat |
71 |
71 |
$1K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
28 |
28 |
$953.63 |
| E0241 |
Bath tub wall rail, each |
32 |
32 |
$867.61 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
15 |
15 |
$819.14 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
50 |
50 |
$753.64 |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
24 |
24 |
$461.22 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
13 |
12 |
$314.45 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
26 |
26 |
$229.83 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$196.20 |