| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
5,059 |
4,665 |
$1.63M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
14,637 |
14,279 |
$1.28M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12,181 |
9,959 |
$1.04M |
| A4927 |
Gloves, non-sterile, per 100 |
51,816 |
50,453 |
$1.01M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
7,764 |
7,028 |
$900K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
9,949 |
9,715 |
$868K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
11,612 |
11,280 |
$860K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
3,431 |
3,203 |
$801K |
| S9999 |
Sales tax |
15,616 |
14,324 |
$780K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
892 |
796 |
$709K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
19,353 |
18,943 |
$683K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
21,629 |
21,031 |
$682K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
5,821 |
5,448 |
$631K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
2,546 |
2,384 |
$629K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
3,496 |
3,149 |
$606K |
| T4541 |
Incontinence product, disposable underpad, large, each |
13,884 |
13,520 |
$601K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,185 |
1,366 |
$522K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
7,503 |
6,901 |
$512K |
| 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 |
6,476 |
4,493 |
$450K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,739 |
4,612 |
$445K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,701 |
4,590 |
$383K |
| 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 |
7,112 |
4,586 |
$339K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,589 |
3,361 |
$288K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
10,195 |
9,372 |
$250K |
| 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 |
2,025 |
1,416 |
$243K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,379 |
1,351 |
$217K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
4,703 |
4,283 |
$210K |
| A4452 |
Tape, waterproof, per 18 square inches |
9,315 |
8,586 |
$191K |
| A4335 |
Incontinence supply; miscellaneous |
6,635 |
6,468 |
$171K |
| K0005 |
Ultralightweight wheelchair |
76 |
71 |
$153K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
2,561 |
2,393 |
$147K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
453 |
423 |
$128K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,840 |
1,789 |
$126K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,379 |
961 |
$124K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,498 |
2,294 |
$123K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
727 |
677 |
$105K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
949 |
838 |
$98K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,365 |
1,258 |
$86K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
329 |
307 |
$80K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,210 |
2,022 |
$78K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,039 |
998 |
$76K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
1,004 |
904 |
$76K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,404 |
2,177 |
$74K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,547 |
1,505 |
$71K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,499 |
1,427 |
$69K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
854 |
747 |
$58K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
1,144 |
1,062 |
$54K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
515 |
476 |
$53K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
10,821 |
10,139 |
$51K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
736 |
672 |
$50K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,198 |
1,099 |
$48K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
369 |
338 |
$46K |
| K0001 |
Standard wheelchair |
3,389 |
3,266 |
$43K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
305 |
287 |
$42K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
544 |
502 |
$41K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
532 |
474 |
$37K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,881 |
1,734 |
$37K |
| E2203 |
Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches |
80 |
72 |
$36K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
145 |
133 |
$36K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
2,711 |
2,449 |
$34K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,255 |
2,172 |
$34K |
| K0004 |
High strength, lightweight wheelchair |
158 |
148 |
$32K |
| A5120 |
Skin barrier, wipes or swabs, each |
6,088 |
5,527 |
$30K |
| E2615 |
Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware |
65 |
64 |
$27K |
| A4456 |
Adhesive remover, wipes, any type, each |
4,176 |
3,795 |
$26K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
114 |
111 |
$22K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
1,469 |
1,434 |
$21K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,686 |
2,496 |
$20K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
647 |
609 |
$18K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
921 |
851 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
932 |
903 |
$18K |
| K0040 |
Adjustable angle footplate, each |
148 |
139 |
$16K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
911 |
861 |
$16K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
1,070 |
1,016 |
$16K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
539 |
513 |
$14K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
419 |
405 |
$13K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
457 |
422 |
$13K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
6,452 |
6,033 |
$13K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
420 |
401 |
$12K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
47 |
41 |
$12K |
| A4367 |
Ostomy belt, each |
1,829 |
1,684 |
$10K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
247 |
234 |
$10K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
30 |
26 |
$8K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,038 |
927 |
$8K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
149 |
141 |
$8K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
239 |
225 |
$7K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
37 |
24 |
$7K |
| A4371 |
Ostomy skin barrier, powder, per oz |
2,092 |
1,960 |
$5K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
213 |
165 |
$4K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
44 |
43 |
$4K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
243 |
242 |
$4K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
382 |
367 |
$3K |
| E0294 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress |
31 |
30 |
$3K |
| A4402 |
Lubricant, per ounce |
877 |
821 |
$3K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
40 |
37 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
737 |
675 |
$3K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
827 |
477 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
47 |
47 |
$2K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
286 |
255 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
135 |
135 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
29 |
28 |
$2K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
69 |
57 |
$2K |
| E0156 |
Seat attachment, walker |
164 |
159 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
239 |
225 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
186 |
172 |
$972.61 |
| K0002 |
Standard hemi (low seat) wheelchair |
100 |
95 |
$639.45 |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
26 |
26 |
$491.99 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
12 |
12 |
$326.10 |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
18 |
18 |
$44.47 |
| E1399 |
Durable medical equipment, miscellaneous |
20 |
20 |
$6.59 |