| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,571 |
1,505 |
$797K |
| T4541 |
Incontinence product, disposable underpad, large, each |
10,631 |
10,600 |
$472K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,563 |
2,555 |
$204K |
| E1399 |
Durable medical equipment, miscellaneous |
299 |
216 |
$185K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,348 |
2,333 |
$141K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,469 |
2,468 |
$127K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,719 |
2,712 |
$106K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,521 |
1,518 |
$101K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,384 |
1,380 |
$90K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,214 |
1,214 |
$86K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
900 |
886 |
$76K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,055 |
1,040 |
$64K |
| A4217 |
Sterile water/saline, 500 ml |
1,271 |
1,231 |
$63K |
| E0601 |
Continuous positive airway pressure (cpap) device |
753 |
744 |
$59K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,943 |
2,883 |
$55K |
| A4670 |
Automatic blood pressure monitor |
451 |
449 |
$41K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
822 |
814 |
$40K |
| K0001 |
Standard wheelchair |
470 |
449 |
$37K |
| A7030 |
Full face mask used with positive airway pressure device, each |
305 |
305 |
$29K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
147 |
61 |
$26K |
| A4335 |
Incontinence supply; miscellaneous |
1,260 |
1,257 |
$25K |
| E0570 |
Nebulizer, with compressor |
293 |
291 |
$25K |
| 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 |
57 |
57 |
$23K |
| 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 |
214 |
211 |
$21K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
388 |
385 |
$21K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
336 |
334 |
$19K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
688 |
635 |
$19K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
407 |
403 |
$19K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
946 |
945 |
$16K |
| A4927 |
Gloves, non-sterile, per 100 |
1,235 |
1,228 |
$14K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
381 |
380 |
$14K |
| A7037 |
Tubing used with positive airway pressure device |
916 |
912 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
869 |
867 |
$12K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
528 |
515 |
$11K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
56 |
56 |
$11K |
| 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 |
78 |
78 |
$8K |
| A7031 |
Face mask interface, replacement for full face mask, each |
215 |
215 |
$8K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
28 |
27 |
$8K |
| A6256 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
103 |
103 |
$8K |
| A6447 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard |
208 |
208 |
$6K |
| A5112 |
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each |
86 |
85 |
$5K |
| E0156 |
Seat attachment, walker |
431 |
428 |
$5K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
133 |
133 |
$5K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,134 |
1,131 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,160 |
1,154 |
$5K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
27 |
26 |
$4K |
| A7036 |
Chinstrap used with positive airway pressure device |
606 |
605 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
24 |
24 |
$4K |
| A4402 |
Lubricant, per ounce |
424 |
424 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
110 |
109 |
$2K |
| A4332 |
Lubricant, individual sterile packet, each |
264 |
263 |
$2K |
| 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 |
26 |
26 |
$2K |
| 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 |
16 |
15 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
81 |
81 |
$2K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
12 |
12 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
16 |
16 |
$790.79 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
32 |
31 |
$743.40 |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
146 |
65 |
$723.06 |
| 99243 |
|
12 |
12 |
$649.85 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
12 |
12 |
$420.84 |
| A7015 |
Aerosol mask, used with dme nebulizer |
18 |
18 |
$12.16 |