| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
28,995 |
28,597 |
$3.01M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
14,672 |
13,963 |
$2.53M |
| T4541 |
Incontinence product, disposable underpad, large, each |
34,070 |
33,421 |
$2.18M |
| E0601 |
Continuous positive airway pressure (cpap) device |
21,378 |
20,694 |
$1.67M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
13,655 |
13,326 |
$1.59M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13,952 |
13,786 |
$1.58M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,765 |
6,087 |
$1.21M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
6,765 |
6,445 |
$1.19M |
| A7030 |
Full face mask used with positive airway pressure device, each |
8,891 |
8,576 |
$1.08M |
| A7031 |
Face mask interface, replacement for full face mask, each |
7,674 |
7,564 |
$1.07M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
7,251 |
7,122 |
$844K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
13,718 |
13,186 |
$672K |
| B9998 |
Noc for enteral supplies |
1,679 |
956 |
$667K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,011 |
3,893 |
$591K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
3,354 |
3,302 |
$523K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,203 |
3,085 |
$494K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,558 |
2,405 |
$444K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
6,113 |
5,910 |
$416K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
473 |
451 |
$300K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,078 |
2,046 |
$287K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,432 |
2,398 |
$279K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14,309 |
13,986 |
$268K |
| E1399 |
Durable medical equipment, miscellaneous |
1,583 |
1,492 |
$259K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,943 |
1,917 |
$231K |
| K0001 |
Standard wheelchair |
3,748 |
3,431 |
$230K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,031 |
988 |
$221K |
| A7035 |
Headgear used with positive airway pressure device |
8,811 |
8,408 |
$219K |
| E0570 |
Nebulizer, with compressor |
2,257 |
2,104 |
$211K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,621 |
1,601 |
$176K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,343 |
1,188 |
$172K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,692 |
3,226 |
$163K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
417 |
409 |
$163K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,951 |
1,873 |
$149K |
| A4927 |
Gloves, non-sterile, per 100 |
6,342 |
6,188 |
$146K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,588 |
1,120 |
$131K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
833 |
747 |
$121K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
698 |
667 |
$114K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
668 |
653 |
$101K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
66 |
60 |
$99K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
6,497 |
6,285 |
$95K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
427 |
416 |
$89K |
| A4670 |
Automatic blood pressure monitor |
304 |
205 |
$89K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
660 |
640 |
$89K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,034 |
913 |
$87K |
| K0004 |
High strength, lightweight wheelchair |
761 |
657 |
$87K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,717 |
1,561 |
$85K |
| 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 |
580 |
542 |
$84K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
689 |
606 |
$76K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
1,394 |
1,235 |
$73K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
383 |
337 |
$68K |
| A4649 |
Surgical supply; miscellaneous |
173 |
120 |
$67K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
354 |
322 |
$58K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,004 |
1,839 |
$55K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
309 |
306 |
$44K |
| E0244 |
Raised toilet seat |
673 |
644 |
$42K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
175 |
170 |
$42K |
| A7000 |
Canister, disposable, used with suction pump, each |
909 |
800 |
$42K |
| A7526 |
Tracheostomy tube collar/holder, each |
460 |
409 |
$39K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
839 |
749 |
$39K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,174 |
1,069 |
$30K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,467 |
2,257 |
$30K |
| E0241 |
Bath tub wall rail, each |
769 |
745 |
$29K |
| A4217 |
Sterile water/saline, 500 ml |
458 |
373 |
$27K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
31 |
25 |
$26K |
| A7037 |
Tubing used with positive airway pressure device |
981 |
975 |
$25K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
162 |
159 |
$21K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
197 |
181 |
$18K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
156 |
127 |
$16K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
575 |
546 |
$14K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
65 |
61 |
$13K |
| 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 |
72 |
66 |
$11K |
| E0156 |
Seat attachment, walker |
369 |
325 |
$9K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
73 |
69 |
$8K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
691 |
594 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
529 |
427 |
$7K |
| A7002 |
Tubing, used with suction pump, each |
879 |
783 |
$7K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
26 |
26 |
$6K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
40 |
39 |
$6K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
552 |
541 |
$6K |
| E0243 |
Toilet rail, each |
82 |
81 |
$6K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
429 |
392 |
$6K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
52 |
50 |
$4K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
26 |
26 |
$3K |
| E0246 |
Transfer tub rail attachment |
43 |
40 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
694 |
669 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
322 |
252 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
228 |
186 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
727 |
662 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
50 |
37 |
$603.50 |
| A7036 |
Chinstrap used with positive airway pressure device |
38 |
38 |
$392.16 |