| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
6,278 |
3,505 |
$3.15M |
| E0465 |
Home vent invasive interface |
4,165 |
2,722 |
$2.46M |
| A4927 |
Non-sterile gloves |
115,902 |
111,859 |
$2.29M |
| T4527 |
Adult size pull-on lg |
14,466 |
14,163 |
$1.84M |
| T4537 |
Reusable underpad bed size |
45,184 |
44,333 |
$1.79M |
| T4523 |
Adult size brief/diaper lg |
11,094 |
10,796 |
$1.56M |
| T4528 |
Adult size pull-on xl |
11,631 |
11,423 |
$1.41M |
| T4526 |
Adult size pull-on med |
12,523 |
12,197 |
$1.40M |
| K0108 |
W/c component-accessory nos |
8,038 |
5,820 |
$1.17M |
| T4543 |
Adult disp brief/diap abv xl |
3,919 |
3,805 |
$1.14M |
| E1007 |
Pwr seat combo w/shear |
388 |
360 |
$1.13M |
| T4522 |
Adult size brief/diaper med |
10,324 |
8,254 |
$1.08M |
| T4541 |
Large disposable underpad |
45,880 |
44,944 |
$985K |
| T4524 |
Adult size brief/diaper xl |
6,260 |
6,115 |
$894K |
| T4535 |
Disposable liner/shield/pad |
17,375 |
16,994 |
$805K |
| T4544 |
Adlt disp und/pull on abv xl |
3,813 |
3,707 |
$725K |
| T4534 |
Youth size pull-on |
4,718 |
4,397 |
$659K |
| K0823 |
Pwc gp 2 std cap chair |
1,671 |
1,566 |
$623K |
| E1390 |
Oxygen concentrator |
7,506 |
7,282 |
$606K |
| B4035 |
Enteral feed supp pump per d |
14,859 |
10,004 |
$575K |
| E1028 |
W/c manual swingaway |
9,208 |
7,725 |
$550K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
295 |
265 |
$525K |
| A4351 |
Straight tip urine catheter |
4,086 |
3,839 |
$496K |
| B4152 |
Ef calorie dense>/=1.5kcal |
14,414 |
9,821 |
$454K |
| E1161 |
Manual adult wc w tiltinspac |
3,879 |
3,599 |
$441K |
| K0005 |
Ultralightweight wheelchair |
615 |
565 |
$374K |
| B4150 |
Ef complet w/intact nutrient |
14,246 |
8,286 |
$368K |
| B4100 |
Food thickener oral |
7,324 |
6,833 |
$342K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,484 |
1,255 |
$320K |
| E2311 |
Electro connect btw 2 sys |
394 |
372 |
$302K |
| B4153 |
Ef hydrolyzed/amino acids |
6,007 |
2,633 |
$301K |
| A4624 |
Tracheal suction tube |
5,480 |
3,176 |
$280K |
| A4353 |
Intermittent urinary cath |
564 |
524 |
$280K |
| E0260 |
Hosp bed semi-electr w/ matt |
6,806 |
6,330 |
$247K |
| A4605 |
Trach suction cath close sys |
2,805 |
1,044 |
$209K |
| E2361 |
22nf sealed leadacid battery |
1,469 |
1,375 |
$189K |
| B4154 |
Ef spec metabolic noninherit |
3,884 |
2,532 |
$179K |
| E0955 |
Cushioned headrest |
5,391 |
4,774 |
$168K |
| A4409 |
Ost skn barr convex <=4 sq i |
3,009 |
2,868 |
$160K |
| K0739 |
Repair/svc dme non-oxygen eq |
8,987 |
8,149 |
$150K |
| E0973 |
W/ch access det adj armrest |
3,362 |
2,731 |
$149K |
| E1012 |
Ctr mount pwr elev leg rest |
365 |
342 |
$140K |
| T4530 |
Ped size brief/diaper lg |
1,032 |
1,018 |
$139K |
| K0040 |
Adjustable angle footplate |
2,479 |
1,978 |
$122K |
| A4385 |
Ost skn barrier sld ext wear |
2,471 |
2,352 |
$120K |
| E0601 |
Cont airway pressure device |
2,044 |
1,999 |
$112K |
| A6212 |
Foam drg <=16 sq in w/border |
967 |
862 |
$95K |
| E2620 |
Wc planar back cush wd <22in |
384 |
356 |
$90K |
| A4606 |
Oxygen probe used w oximeter |
1,120 |
864 |
$89K |
| W0137 |
|
483 |
477 |
$88K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,054 |
996 |
$87K |
| A7526 |
Tracheostomy tube collar |
7,073 |
4,693 |
$86K |
| E2607 |
Skin pro/pos wc cus wd <22in |
676 |
643 |
$84K |
| E0971 |
Wheelchair anti-tipping devi |
2,731 |
2,157 |
$79K |
| E0570 |
Nebulizer with compression |
6,514 |
6,254 |
$77K |
| A7030 |
Cpap full face mask |
878 |
834 |
$74K |
| K0004 |
High strength ltwt whlchr |
2,979 |
2,819 |
$73K |
| B4034 |
Enter feed supkit syr by day |
1,613 |
1,342 |
$66K |
| A4239 |
Non-adju cgm supply allow |
1,080 |
987 |
$66K |
| E2377 |
Expandable controller, initl |
410 |
372 |
$65K |
| E2622 |
Adj skin pro w/c cus wd<22in |
563 |
538 |
$62K |
| K0821 |
Pwc gp 2 std port cap chair |
71 |
69 |
$60K |
| E0630 |
Patient lift hydraulic |
2,687 |
2,560 |
$58K |
| A4425 |
Ost pch drain for barrier fl |
1,534 |
1,485 |
$58K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,401 |
1,329 |
$56K |
| A4623 |
Tracheostomy inner cannula |
3,074 |
2,768 |
$54K |
| T4521 |
Adult size brief/diaper sm |
459 |
398 |
$52K |
| E0978 |
W/c acc,saf belt pelv strap |
2,673 |
2,441 |
$51K |
| E2611 |
Gen use back cush wdth <22in |
545 |
512 |
$50K |
| E0431 |
Portable gaseous 02 |
3,124 |
3,028 |
$48K |
| E0956 |
W/c lateral trunk/hip suppor |
554 |
467 |
$45K |
| E0562 |
Humidifier heated used w pap |
303 |
293 |
$44K |
| A4335 |
Incontinence supply |
3,360 |
3,197 |
$43K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
592 |
527 |
$42K |
| E2313 |
Pwc harness, expand control |
422 |
383 |
$42K |
| A5063 |
Drain ostomy pouch w/flange |
1,671 |
1,618 |
$40K |
| B9002 |
Enter nutr inf pump any type |
2,492 |
2,389 |
$39K |
| E2395 |
Caster wheel excludes tire |
748 |
640 |
$39K |
| A7034 |
Nasal application device |
641 |
618 |
$38K |
| K0001 |
Standard wheelchair |
2,926 |
2,815 |
$38K |
| A4629 |
Tracheostomy care kit |
1,993 |
1,755 |
$38K |
| E0600 |
Suction pump portab hom modl |
1,741 |
1,641 |
$38K |
| A6402 |
Sterile gauze <= 16 sq in |
7,204 |
5,137 |
$36K |
| A4604 |
Tubing with heating element |
1,073 |
1,036 |
$36K |
| K0553 |
Ther cgm supply allowance |
289 |
265 |
$34K |
| B4155 |
Ef incomplete/modular |
7,577 |
4,960 |
$32K |
| E0960 |
W/c shoulder harness/straps |
798 |
730 |
$29K |
| K0800 |
Pov group 1 std up to 300lbs |
72 |
62 |
$29K |
| E2213 |
Pneumatic prop tire insert |
1,436 |
1,121 |
$29K |
| E2211 |
Pneumatic propulsion tire |
1,094 |
866 |
$28K |
| A4362 |
Solid skin barrier |
1,384 |
1,313 |
$28K |
| A7520 |
Trach/laryn tube non-cuffed |
1,585 |
1,459 |
$27K |
| E0445 |
Oximeter non-invasive |
865 |
849 |
$26K |
| B4036 |
Enteral feed sup kit grav by |
603 |
479 |
$26K |
| A4427 |
Ost pch drain/barr lk flng/f |
890 |
865 |
$25K |
| E0951 |
Loop heel |
1,803 |
1,432 |
$24K |
| E0627 |
Seat lift mech, electric any |
286 |
278 |
$24K |
| A4357 |
Bedside drainage bag |
5,184 |
4,915 |
$22K |
| A4352 |
Coude tip urinary catheter |
61 |
59 |
$22K |
| K0825 |
Pwc gp 2 hd cap chair |
29 |
26 |
$21K |
| A4628 |
Oropharyngeal suction cath |
2,639 |
1,519 |
$21K |
| A4456 |
Adhesive remover, wipes |
3,932 |
3,717 |
$20K |
| E0950 |
Tray |
420 |
384 |
$20K |
| K0003 |
Lightweight wheelchair |
555 |
526 |
$19K |
| A4349 |
Disposable male external cat |
1,490 |
1,390 |
$18K |
| A5120 |
Skin barrier, wipe or swab |
4,099 |
3,946 |
$18K |
| A7031 |
Replacement facemask interfa |
600 |
543 |
$17K |
| E2394 |
Drive wheel excludes tire |
389 |
347 |
$17K |
| A7010 |
Disposable corrugated tubing |
2,063 |
1,753 |
$17K |
| B9998 |
Enteral supp not otherwise c |
190 |
166 |
$16K |
| E0240 |
Bath/shower chair |
55 |
50 |
$16K |
| A4419 |
Ost pch for bar w flange/flt |
466 |
423 |
$15K |
| A7002 |
Tubing used w suction pump |
5,902 |
4,339 |
$15K |
| E0194 |
Air fluidized bed |
14 |
12 |
$15K |
| E2389 |
Foam caster tire |
642 |
543 |
$15K |
| A7000 |
Disposable canister for pump |
4,921 |
3,687 |
$15K |
| E0255 |
Hospital bed var ht w/ mattr |
515 |
479 |
$14K |
| E2231 |
Solid seat support base |
345 |
300 |
$14K |
| A4394 |
Ostomy pouch liq deodorant |
1,391 |
1,331 |
$14K |
| A7046 |
Repl water chamber, pap dev |
1,659 |
1,477 |
$14K |
| E2300 |
Pwr seat elevation sys |
15 |
12 |
$13K |
| E0143 |
Walker folding wheeled w/o s |
313 |
301 |
$13K |
| A4332 |
Lube sterile packet |
1,538 |
1,496 |
$13K |
| E2386 |
Foam filled drive wheel tire |
155 |
137 |
$13K |
| E2601 |
Gen w/c cushion wdth < 22 in |
712 |
666 |
$13K |
| A7035 |
Pos airway press headgear |
815 |
770 |
$13K |
| E0265 |
Hosp bed total electr w/ mat |
1,476 |
1,453 |
$12K |
| A7037 |
Pos airway pressure tubing |
692 |
606 |
$12K |
| A4452 |
Waterproof tape |
1,393 |
1,270 |
$12K |
| A4406 |
Pectin based ostomy paste |
2,465 |
2,345 |
$11K |
| E0953 |
W/c lateral thigh/knee sup |
236 |
204 |
$11K |
| E2613 |
Position back cush wd <22in |
70 |
67 |
$11K |
| E2219 |
Foam caster tire any size ea |
379 |
310 |
$11K |
| A7038 |
Pos airway pressure filter |
2,564 |
2,402 |
$10K |
| B4087 |
Gastro/jejuno tube, std |
1,832 |
1,706 |
$10K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,191 |
1,065 |
$9K |
| E0181 |
Press pad alternating w/ pum |
1,298 |
1,208 |
$9K |
| A7003 |
Nebulizer administration set |
5,290 |
4,046 |
$9K |
| E0961 |
Wheelchair brake extension |
514 |
425 |
$9K |
| K0019 |
Arm pad repl, each |
927 |
750 |
$9K |
| A6446 |
Conform band s w>=3" <5"/yd |
424 |
364 |
$9K |
| A4618 |
Breathing circuits |
661 |
499 |
$8K |
| K0007 |
Extra heavy duty wheelchair |
478 |
458 |
$8K |
| E2617 |
Custom fab w/c back cushion |
17 |
12 |
$8K |
| A7045 |
Repl exhalation port for pap |
739 |
559 |
$8K |
| K0195 |
Elevating whlchair leg rests |
2,220 |
2,038 |
$8K |
| A4216 |
Sterile water/saline, 10 ml |
2,353 |
883 |
$8K |
| A4520 |
Incontinence garment anytype |
294 |
277 |
$7K |
| A4432 |
Os pch urine w bar/fange/tap |
206 |
199 |
$7K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,098 |
1,000 |
$7K |
| E2366 |
Battery charger, single mode |
68 |
66 |
$7K |
| E0776 |
Iv pole |
1,396 |
1,350 |
$6K |
| E0565 |
Compressor air power source |
206 |
199 |
$6K |
| A4553 |
Nondisp underpads, all sizes |
247 |
236 |
$6K |
| A7020 |
Interface, cough stim device |
272 |
250 |
$6K |
| A7007 |
Lg vol nebulizer disposable |
2,236 |
1,562 |
$6K |
| E0325 |
Urinal male jug-type |
1,337 |
1,246 |
$5K |
| A4554 |
Disposable underpads |
599 |
570 |
$5K |
| A4358 |
Urinary leg or abdomen bag |
1,778 |
1,697 |
$5K |
| T4532 |
Ped size pull-on lg |
26 |
26 |
$4K |
| A4311 |
Catheter w/o bag 2-way latex |
584 |
559 |
$4K |
| E2210 |
Wheelchair bearings |
469 |
431 |
$4K |
| A7525 |
Tracheostomy mask |
4,634 |
2,583 |
$4K |
| A4344 |
Cath indw foley 2 way silicn |
81 |
56 |
$4K |
| A6196 |
Alginate dressing <=16 sq in |
37 |
29 |
$4K |
| A4314 |
Cath w/drainage 2-way latex |
1,242 |
1,143 |
$3K |
| A4402 |
Lubricant per ounce |
1,006 |
941 |
$3K |
| K0738 |
Portable gas oxygen system |
192 |
166 |
$3K |
| A4310 |
Insert tray w/o bag/cath |
604 |
562 |
$3K |
| A7521 |
Trach/laryn tube cuffed |
104 |
98 |
$3K |
| E0482 |
Cough stimulating device |
12 |
12 |
$2K |
| A4649 |
Surgical supplies |
92 |
81 |
$2K |
| A5056 |
1 pc ost pouch w filter |
56 |
52 |
$2K |
| A6219 |
Gauze <= 16 sq in w/border |
159 |
145 |
$2K |
| A4338 |
Indwelling catheter latex |
426 |
399 |
$2K |
| A4371 |
Skin barrier powder per oz |
1,339 |
1,293 |
$2K |
| A4450 |
Non-waterproof tape |
1,162 |
1,039 |
$2K |
| A4483 |
Moisture exchanger |
384 |
303 |
$2K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
29 |
25 |
$2K |
| E0149 |
Heavy duty wheeled walker |
122 |
120 |
$2K |
| E1038 |
Transport chair pt wt<=300lb |
294 |
288 |
$2K |
| A5073 |
Urinary pouch on barr w/flng |
56 |
56 |
$2K |
| A6449 |
Lt compres band >=3" <5"/yd |
76 |
70 |
$2K |
| A7032 |
Replacement nasal cushion |
24 |
24 |
$1K |
| A7039 |
Filter, non disposable w pap |
219 |
207 |
$1K |
| E0156 |
Walker seat attachment |
189 |
182 |
$1K |
| K0733 |
12-24hr sealed lead acid |
54 |
54 |
$1K |
| A6454 |
Self-adher band w>=3" <5"/yd |
304 |
286 |
$1K |
| A4500 |
Below knee surgical stocking |
41 |
41 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
1,916 |
1,779 |
$1K |
| A4322 |
Irrigation syringe |
85 |
80 |
$1K |
| E0277 |
Powered pres-redu air mattrs |
108 |
106 |
$1K |
| A4320 |
Irrigation tray |
115 |
114 |
$1K |
| A7033 |
Replacement nasal pillows |
38 |
38 |
$1K |
| A4367 |
Ostomy belt |
378 |
354 |
$785.27 |
| A7012 |
Nebulizer water collec devic |
942 |
707 |
$755.33 |
| E0163 |
Commode chair with fixed arm |
29 |
28 |
$729.85 |
| A4424 |
Ost pch drain w bar & filter |
15 |
14 |
$636.93 |
| E2392 |
Solid caster tire, integrate |
18 |
13 |
$586.68 |
| S8999 |
Resuscitation bag |
17 |
16 |
$578.00 |
| E2208 |
Cylinder tank carrier |
13 |
13 |
$562.00 |
| E0954 |
Foot box, any type each foot |
39 |
34 |
$551.09 |
| T4542 |
Small disposable underpad |
41 |
41 |
$468.84 |
| A4333 |
Urinary cath anchor device |
118 |
112 |
$422.38 |
| E0165 |
Commode chair with detacharm |
38 |
38 |
$389.19 |
| K0077 |
Fr cstr asmb sol tire rep ea |
19 |
12 |
$321.97 |
| E2374 |
Hand/chin ctrl std joystick |
12 |
12 |
$304.12 |
| A6441 |
Pad band w>=3" <5"/yd |
41 |
40 |
$279.68 |
| A7013 |
Disposable compressor filter |
642 |
629 |
$197.52 |
| A6250 |
Skin seal protect moisturizr |
50 |
49 |
$178.23 |
| A6457 |
Tubular dressing |
12 |
12 |
$174.74 |
| A4253 |
Blood glucose/reagent strips |
31 |
28 |
$117.11 |
| K0043 |
Ftrst lowr exten tube rep ea |
14 |
12 |
$115.64 |
| A4217 |
Sterile water/saline, 500 ml |
108 |
83 |
$110.15 |
| A6448 |
Lt compres band <3"/yd |
14 |
14 |
$108.60 |
| A6442 |
Conform band n/s w<3"/yd |
13 |
13 |
$100.80 |
| A7005 |
Nondisposable nebulizer set |
26 |
26 |
$85.12 |
| A4259 |
Lancets per box |
73 |
67 |
$26.51 |
| E0303 |
Hosp bed hvy dty xtra wide |
63 |
63 |
$0.00 |
| Q0513 |
Disp fee inhal drugs/30 days |
17 |
12 |
$0.00 |
| E0184 |
Dry pressure mattress |
508 |
477 |
$0.00 |
| S9342 |
Hit enteral pump diem |
17 |
16 |
$0.00 |