| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,547 |
2,136 |
$419K |
| K0003 |
Lightweight wheelchair |
14,558 |
9,665 |
$346K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
5,824 |
4,152 |
$244K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
7,200 |
4,481 |
$171K |
| K0001 |
Standard wheelchair |
7,617 |
5,559 |
$99K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
592 |
413 |
$93K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,075 |
2,937 |
$92K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,347 |
767 |
$85K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
3,548 |
2,461 |
$83K |
| E0570 |
Nebulizer, with compressor |
1,949 |
1,427 |
$55K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,372 |
1,510 |
$53K |
| A4623 |
Tracheostomy, inner cannula |
1,001 |
548 |
$52K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,126 |
514 |
$44K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
912 |
566 |
$43K |
| K0006 |
Heavy duty wheelchair |
1,771 |
1,093 |
$39K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
2,101 |
1,283 |
$34K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
464 |
345 |
$34K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
470 |
263 |
$30K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,209 |
1,289 |
$24K |
| K0007 |
Extra heavy duty wheelchair |
800 |
440 |
$23K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
364 |
295 |
$23K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,087 |
617 |
$20K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,271 |
1,419 |
$19K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
295 |
216 |
$15K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,196 |
957 |
$15K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
531 |
465 |
$14K |
| A7002 |
Tubing, used with suction pump, each |
2,111 |
1,274 |
$12K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
325 |
97 |
$12K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,856 |
1,106 |
$11K |
| E1140 |
Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
415 |
352 |
$10K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
694 |
432 |
$9K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,414 |
697 |
$8K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
8,671 |
3,028 |
$7K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
155 |
65 |
$6K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,198 |
639 |
$6K |
| E0156 |
Seat attachment, walker |
1,125 |
643 |
$6K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
56 |
24 |
$5K |
| A4930 |
Gloves, sterile, per pair |
257 |
141 |
$4K |
| 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 |
47 |
37 |
$3K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
137 |
81 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
47 |
37 |
$1K |
| E0272 |
Mattress, foam rubber |
43 |
30 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,201 |
957 |
$1K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
383 |
183 |
$743.78 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
13 |
12 |
$332.88 |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
15 |
12 |
$325.58 |
| E0305 |
Bed side rails, half length |
166 |
126 |
$150.16 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
113 |
93 |
$87.56 |