| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
4,443 |
3,717 |
$1.08M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,426 |
4,175 |
$410K |
| 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 |
1,584 |
1,448 |
$286K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,518 |
1,321 |
$279K |
| K0004 |
High strength, lightweight wheelchair |
3,280 |
3,025 |
$154K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,790 |
3,398 |
$150K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
2,008 |
1,789 |
$118K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,697 |
3,455 |
$114K |
| K0003 |
Lightweight wheelchair |
1,161 |
1,074 |
$59K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,918 |
1,722 |
$51K |
| E0245 |
Tub stool or bench |
1,225 |
1,161 |
$42K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
942 |
888 |
$38K |
| A4927 |
Gloves, non-sterile, per 100 |
2,173 |
2,018 |
$28K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
195 |
180 |
$22K |
| E0244 |
Raised toilet seat |
447 |
422 |
$17K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
324 |
252 |
$16K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
192 |
177 |
$15K |
| 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 |
143 |
127 |
$15K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
323 |
262 |
$13K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
503 |
453 |
$13K |
| A4670 |
Automatic blood pressure monitor |
318 |
299 |
$12K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
122 |
112 |
$11K |
| E0243 |
Toilet rail, each |
358 |
316 |
$11K |
| E0156 |
Seat attachment, walker |
1,367 |
1,211 |
$9K |
| E0627 |
Seat lift mechanism, electric, any type |
780 |
699 |
$9K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
343 |
322 |
$6K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
221 |
181 |
$6K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
77 |
71 |
$6K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
413 |
376 |
$5K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
136 |
121 |
$5K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
67 |
56 |
$4K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
183 |
167 |
$4K |
| E0570 |
Nebulizer, with compressor |
333 |
322 |
$4K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
155 |
144 |
$4K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
219 |
218 |
$3K |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
267 |
233 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
179 |
165 |
$2K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
135 |
121 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
15 |
14 |
$2K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
13 |
13 |
$1K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
133 |
106 |
$1K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
137 |
124 |
$1K |
| E0246 |
Transfer tub rail attachment |
28 |
26 |
$1K |
| E0241 |
Bath tub wall rail, each |
28 |
27 |
$537.39 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
46 |
41 |
$0.00 |
| A9270 |
Non-covered item or service |
139 |
125 |
$0.00 |