| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
70,651 |
70,510 |
$3.70M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
56,176 |
53,592 |
$2.86M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13,475 |
13,429 |
$785K |
| V5298 |
Hearing aid, not otherwise classified |
417 |
417 |
$577K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
38,736 |
38,716 |
$454K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
8,740 |
8,717 |
$410K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
52,150 |
52,105 |
$409K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
5,288 |
5,270 |
$362K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,260 |
4,248 |
$235K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,385 |
2,323 |
$157K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
3,664 |
3,650 |
$116K |
| K0001 |
Standard wheelchair |
3,956 |
3,954 |
$98K |
| E0245 |
Tub stool or bench |
1,621 |
1,611 |
$93K |
| A4335 |
Incontinence supply; miscellaneous |
27,091 |
27,056 |
$90K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,371 |
1,220 |
$90K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,299 |
1,299 |
$88K |
| 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 |
434 |
404 |
$80K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,847 |
1,845 |
$58K |
| A4217 |
Sterile water/saline, 500 ml |
2,145 |
1,913 |
$51K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
901 |
897 |
$47K |
| K0003 |
Lightweight wheelchair |
1,501 |
1,500 |
$46K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,588 |
2,307 |
$43K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,092 |
1,091 |
$32K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
140 |
134 |
$29K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
749 |
433 |
$28K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
345 |
345 |
$28K |
| E0570 |
Nebulizer, with compressor |
994 |
992 |
$27K |
| V5014 |
Repair/modification of a hearing aid |
582 |
572 |
$26K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
494 |
489 |
$25K |
| 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 |
360 |
319 |
$25K |
| 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 |
841 |
480 |
$24K |
| 92557 |
|
363 |
360 |
$23K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
446 |
446 |
$22K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
206 |
206 |
$19K |
| A6255 |
Specialty absorptive 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 |
110 |
105 |
$16K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
651 |
593 |
$13K |
| 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 |
30 |
28 |
$13K |
| V5008 |
Hearing screening |
786 |
772 |
$12K |
| E0156 |
Seat attachment, walker |
1,555 |
1,552 |
$12K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,754 |
1,754 |
$11K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
88 |
88 |
$9K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
484 |
450 |
$8K |
| 92567 |
|
376 |
373 |
$8K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
140 |
129 |
$8K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
333 |
226 |
$7K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,338 |
1,278 |
$6K |
| A5120 |
Skin barrier, wipes or swabs, each |
581 |
576 |
$6K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
276 |
276 |
$5K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
355 |
355 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
184 |
174 |
$5K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
15 |
13 |
$5K |
| E0271 |
Mattress, innerspring |
258 |
258 |
$5K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
47 |
41 |
$4K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
206 |
206 |
$4K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
42 |
42 |
$4K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
115 |
115 |
$4K |
| K0006 |
Heavy duty wheelchair |
63 |
63 |
$4K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
330 |
330 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
221 |
221 |
$3K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
39 |
37 |
$1K |
| V5010 |
Assessment for hearing aid |
24 |
24 |
$1K |
| L0972 |
Lso, corset front |
136 |
136 |
$1K |
| V5264 |
Ear mold/insert, not disposable, any type |
22 |
22 |
$1K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
26 |
25 |
$1K |
| A4259 |
Lancets, per box of 100 |
1,282 |
1,231 |
$839.16 |
| A4927 |
Gloves, non-sterile, per 100 |
591 |
582 |
$830.03 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
107 |
54 |
$731.88 |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
14 |
14 |
$644.41 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
54 |
54 |
$438.34 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
13 |
12 |
$415.78 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
13 |
13 |
$414.13 |
| E0210 |
Electric heat pad, standard |
25 |
25 |
$395.40 |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
69 |
69 |
$394.70 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
43 |
43 |
$316.76 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
12 |
12 |
$230.73 |
| E0272 |
Mattress, foam rubber |
12 |
12 |
$188.40 |
| E0305 |
Bed side rails, half length |
12 |
12 |
$152.64 |
| A4256 |
Normal, low and high calibrator solution / chips |
29 |
29 |
$14.78 |