| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
2,173 |
1,613 |
$451K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,715 |
1,611 |
$400K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
5,801 |
5,295 |
$346K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,396 |
1,038 |
$273K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
5,602 |
5,294 |
$250K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,651 |
1,861 |
$184K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,890 |
2,462 |
$184K |
| K0001 |
Standard wheelchair |
7,645 |
6,689 |
$180K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
325 |
300 |
$151K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
1,410 |
1,324 |
$90K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
761 |
677 |
$82K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,477 |
1,861 |
$72K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
307 |
283 |
$54K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
449 |
347 |
$40K |
| L3650 |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
841 |
793 |
$38K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,037 |
1,837 |
$33K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
242 |
226 |
$30K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
257 |
172 |
$28K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
271 |
245 |
$28K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
384 |
283 |
$22K |
| A6210 |
Foam 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 |
177 |
132 |
$20K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,100 |
1,747 |
$17K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
895 |
702 |
$15K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,735 |
1,362 |
$12K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
279 |
195 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,024 |
919 |
$11K |
| A4452 |
Tape, waterproof, per 18 square inches |
407 |
328 |
$9K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
507 |
478 |
$8K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
70 |
69 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,027 |
825 |
$7K |
| L3260 |
Surgical boot/shoe, each |
480 |
437 |
$7K |
| 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 |
86 |
70 |
$6K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
666 |
562 |
$6K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
64 |
62 |
$5K |
| L3924 |
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf |
51 |
38 |
$2K |
| K0004 |
High strength, lightweight wheelchair |
36 |
25 |
$1K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
50 |
38 |
$983.02 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
643 |
554 |
$966.47 |
| A4217 |
Sterile water/saline, 500 ml |
117 |
105 |
$655.99 |
| E1399 |
Durable medical equipment, miscellaneous |
13 |
12 |
$325.00 |
| A4565 |
Slings |
15 |
12 |
$90.03 |