| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
12,110 |
10,546 |
$2.10M |
| A4554 |
Disposable underpads, all sizes |
24,911 |
21,061 |
$1.32M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
16,353 |
14,036 |
$979K |
| A4927 |
Gloves, non-sterile, per 100 |
28,773 |
24,549 |
$749K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
24,571 |
20,474 |
$731K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,738 |
3,831 |
$624K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,121 |
2,476 |
$499K |
| E0221 |
Infrared heating pad system |
209 |
122 |
$431K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,348 |
2,530 |
$317K |
| 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 |
1,082 |
910 |
$243K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,485 |
1,104 |
$177K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
699 |
623 |
$168K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
248 |
205 |
$133K |
| E0172 |
Seat lift mechanism placed over or on top of toilet, any type |
68 |
44 |
$103K |
| E1399 |
Durable medical equipment, miscellaneous |
143 |
115 |
$93K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
589 |
469 |
$89K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
612 |
329 |
$76K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
392 |
88 |
$75K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
591 |
492 |
$60K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
349 |
282 |
$59K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,450 |
1,345 |
$57K |
| K0001 |
Standard wheelchair |
1,309 |
990 |
$56K |
| E0245 |
Tub stool or bench |
1,206 |
774 |
$44K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
1,216 |
912 |
$41K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,434 |
1,159 |
$40K |
| A4215 |
Needle, sterile, any size, each |
1,338 |
1,189 |
$39K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 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 |
254 |
185 |
$34K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,263 |
955 |
$34K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,786 |
2,425 |
$24K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
91 |
26 |
$20K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
372 |
276 |
$19K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
101 |
38 |
$19K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
80 |
74 |
$17K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
175 |
167 |
$17K |
| A4245 |
Alcohol wipes, per box |
3,213 |
2,867 |
$16K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
55 |
52 |
$15K |
| A4670 |
Automatic blood pressure monitor |
202 |
154 |
$13K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
110 |
102 |
$12K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
19 |
17 |
$12K |
| E0156 |
Seat attachment, walker |
1,100 |
712 |
$10K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
197 |
155 |
$8K |
| E0570 |
Nebulizer, with compressor |
266 |
179 |
$7K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
303 |
249 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
653 |
481 |
$6K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
109 |
98 |
$6K |
| A4259 |
Lancets, per box of 100 |
2,734 |
2,413 |
$5K |
| E0277 |
Powered pressure-reducing air mattress |
25 |
12 |
$4K |
| K0002 |
Standard hemi (low seat) wheelchair |
36 |
28 |
$4K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
39 |
36 |
$3K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
13 |
12 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
24 |
14 |
$2K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
63 |
14 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
46 |
37 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
14 |
12 |
$980.00 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
21 |
12 |
$523.20 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
57 |
24 |
$361.88 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
13 |
12 |
$359.16 |
| A4258 |
Spring-powered device for lancet, each |
125 |
124 |
$357.86 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
18 |
12 |
$312.27 |
| A6260 |
Wound cleansers, any type, any size |
13 |
13 |
$174.88 |