| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
70,651 |
70,510 |
$3.70M |
| T4535 |
Disposable liner/shield/pad |
56,176 |
53,592 |
$2.86M |
| T4527 |
Adult size pull-on lg |
13,475 |
13,429 |
$785K |
| V5298 |
Hearing aid noc |
417 |
417 |
$577K |
| T4536 |
Reusable pull-on any size |
38,736 |
38,716 |
$454K |
| T4526 |
Adult size pull-on med |
8,740 |
8,717 |
$410K |
| A6250 |
Skin seal protect moisturizr |
52,150 |
52,105 |
$409K |
| T4523 |
Adult size brief/diaper lg |
5,288 |
5,270 |
$362K |
| T4528 |
Adult size pull-on xl |
4,260 |
4,248 |
$235K |
| T4524 |
Adult size brief/diaper xl |
2,385 |
2,323 |
$157K |
| T4537 |
Reusable underpad bed size |
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 |
27,091 |
27,056 |
$90K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,371 |
1,220 |
$90K |
| E0601 |
Cont airway pressure device |
1,299 |
1,299 |
$88K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
434 |
404 |
$80K |
| E0143 |
Walker folding wheeled w/o s |
1,847 |
1,845 |
$58K |
| A4217 |
Sterile water/saline, 500 ml |
2,145 |
1,913 |
$51K |
| T4525 |
Adult size pull-on sm |
901 |
897 |
$47K |
| K0003 |
Lightweight wheelchair |
1,501 |
1,500 |
$46K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,588 |
2,307 |
$43K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,092 |
1,091 |
$32K |
| A6196 |
Alginate dressing <=16 sq in |
140 |
134 |
$29K |
| A5513 |
Multi den insert custom mold |
749 |
433 |
$28K |
| E0295 |
Hosp bed semi-elect w/o matt |
345 |
345 |
$28K |
| E0570 |
Nebulizer with compression |
994 |
992 |
$27K |
| V5014 |
Hearing aid repair/modifying |
582 |
572 |
$26K |
| T4522 |
Adult size brief/diaper med |
494 |
489 |
$25K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
360 |
319 |
$25K |
| A5500 |
Diab shoe for density insert |
841 |
480 |
$24K |
| 92557 |
|
363 |
360 |
$23K |
| E1390 |
Oxygen concentrator |
446 |
446 |
$22K |
| E2611 |
Gen use back cush wdth <22in |
206 |
206 |
$19K |
| A6255 |
Absorpt drg >16<=48 in w/bdr |
110 |
105 |
$16K |
| A6402 |
Sterile gauze <= 16 sq in |
651 |
593 |
$13K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
30 |
28 |
$13K |
| V5008 |
Hearing screening |
786 |
772 |
$12K |
| E0156 |
Walker seat attachment |
1,555 |
1,552 |
$12K |
| E1038 |
Transport chair pt wt<=300lb |
1,754 |
1,754 |
$11K |
| E0603 |
Electric breast pump |
88 |
88 |
$9K |
| A5131 |
Appliance cleaner |
484 |
450 |
$8K |
| 92567 |
|
376 |
373 |
$8K |
| A6240 |
Hydrocolld drg filler paste |
140 |
129 |
$8K |
| L1812 |
Ko elastic w/joints pre ots |
333 |
226 |
$7K |
| A4253 |
Blood glucose/reagent strips |
1,338 |
1,278 |
$6K |
| A5120 |
Skin barrier, wipe or swab |
581 |
576 |
$6K |
| L0621 |
Sio flex pelvic/sacr pre ots |
276 |
276 |
$5K |
| E0261 |
Hosp bed semi-electr w/o mat |
355 |
355 |
$5K |
| A4357 |
Bedside drainage bag |
184 |
174 |
$5K |
| A6010 |
Collagen based wound filler |
15 |
13 |
$5K |
| E0271 |
Mattress innerspring |
258 |
258 |
$5K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
47 |
41 |
$4K |
| E2601 |
Gen w/c cushion wdth < 22 in |
206 |
206 |
$4K |
| E0185 |
Gel pressure mattress pad |
42 |
42 |
$4K |
| E0630 |
Patient lift hydraulic |
115 |
115 |
$4K |
| K0006 |
Heavy duty wheelchair |
63 |
63 |
$4K |
| E0431 |
Portable gaseous 02 |
330 |
330 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
221 |
221 |
$3K |
| A4358 |
Urinary leg or abdomen bag |
39 |
37 |
$1K |
| V5010 |
Assessment for hearing aid |
24 |
24 |
$1K |
| L0972 |
Lso corset front |
136 |
136 |
$1K |
| V5264 |
Ear mold/insert |
22 |
22 |
$1K |
| A5121 |
Solid skin barrier 6x6 |
26 |
25 |
$1K |
| A4259 |
Lancets per box |
1,282 |
1,231 |
$839.16 |
| A4927 |
Non-sterile gloves |
591 |
582 |
$830.03 |
| E0971 |
Wheelchair anti-tipping devi |
107 |
54 |
$731.88 |
| L1810 |
Ko elastic with joints |
14 |
14 |
$644.41 |
| E0961 |
Wheelchair brake extension |
54 |
54 |
$438.34 |
| A4310 |
Insert tray w/o bag/cath |
13 |
12 |
$415.78 |
| E0163 |
Commode chair with fixed arm |
13 |
13 |
$414.13 |
| E0210 |
Electric heat pad standard |
25 |
25 |
$395.40 |
| L8000 |
Mastectomy bra |
69 |
69 |
$394.70 |
| E0100 |
Cane adjust/fixed with tip |
43 |
43 |
$316.76 |
| Q0513 |
Disp fee inhal drugs/30 days |
12 |
12 |
$230.73 |
| E0272 |
Mattress foam rubber |
12 |
12 |
$188.40 |
| E0305 |
Rails bed side half length |
12 |
12 |
$152.64 |
| A4256 |
Calibrator solution/chips |
29 |
29 |
$14.78 |