| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
11,703 |
9,669 |
$2.98M |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,399 |
3,271 |
$1.41M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
8,674 |
8,382 |
$1.11M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,658 |
3,478 |
$927K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,883 |
6,645 |
$243K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,923 |
3,548 |
$157K |
| K0004 |
High strength, lightweight wheelchair |
3,789 |
3,487 |
$137K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
1,822 |
1,692 |
$117K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
939 |
815 |
$88K |
| A4927 |
Gloves, non-sterile, per 100 |
4,168 |
4,017 |
$60K |
| A4670 |
Automatic blood pressure monitor |
1,602 |
1,571 |
$59K |
| K0003 |
Lightweight wheelchair |
1,289 |
1,218 |
$54K |
| E0245 |
Tub stool or bench |
1,394 |
1,349 |
$51K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,987 |
1,840 |
$47K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,297 |
1,178 |
$44K |
| E0243 |
Toilet rail, each |
1,130 |
1,040 |
$36K |
| E0627 |
Seat lift mechanism, electric, any type |
1,319 |
1,169 |
$34K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
162 |
142 |
$28K |
| E0244 |
Raised toilet seat |
672 |
639 |
$27K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
219 |
185 |
$27K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
409 |
367 |
$21K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
127 |
122 |
$19K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
340 |
281 |
$19K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
767 |
699 |
$18K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
282 |
253 |
$17K |
| E0246 |
Transfer tub rail attachment |
355 |
344 |
$17K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
155 |
139 |
$16K |
| E0570 |
Nebulizer, with compressor |
1,145 |
1,101 |
$15K |
| E0241 |
Bath tub wall rail, each |
705 |
654 |
$14K |
| E0156 |
Seat attachment, walker |
1,775 |
1,643 |
$12K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
945 |
940 |
$11K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
585 |
536 |
$11K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
94 |
91 |
$10K |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
1,293 |
1,202 |
$8K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
28 |
26 |
$8K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
286 |
230 |
$7K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
315 |
283 |
$6K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
285 |
258 |
$6K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
240 |
201 |
$5K |
| K0007 |
Extra heavy duty wheelchair |
132 |
119 |
$5K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
42 |
40 |
$4K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
232 |
208 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
281 |
227 |
$3K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
32 |
25 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
259 |
254 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
376 |
340 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
59 |
57 |
$354.67 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
12 |
12 |
$243.31 |
| A9270 |
Non-covered item or service |
730 |
518 |
$0.00 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
72 |
52 |
$0.00 |