| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
123,063 |
122,839 |
$8.35M |
| A4554 |
Disposable underpads, all sizes |
231,856 |
231,456 |
$8.30M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
125,719 |
125,499 |
$6.13M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
135,807 |
135,615 |
$4.22M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
54,338 |
54,223 |
$4.06M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
15,662 |
15,625 |
$2.12M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
53,713 |
53,608 |
$1.26M |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
16,682 |
16,650 |
$740K |
| 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 |
5,951 |
5,922 |
$612K |
| A4335 |
Incontinence supply; miscellaneous |
13,402 |
13,334 |
$549K |
| 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 |
7,137 |
7,107 |
$482K |
| E1399 |
Durable medical equipment, miscellaneous |
3,910 |
3,838 |
$328K |
| A4927 |
Gloves, non-sterile, per 100 |
73,672 |
73,475 |
$278K |
| B9998 |
Noc for enteral supplies |
1,215 |
1,196 |
$273K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
11,485 |
11,467 |
$239K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
7,487 |
7,470 |
$211K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
13,342 |
13,302 |
$204K |
| 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 |
2,267 |
2,253 |
$180K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
10,123 |
10,097 |
$177K |
| A4670 |
Automatic blood pressure monitor |
4,464 |
4,453 |
$175K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,834 |
2,821 |
$138K |
| K0001 |
Standard wheelchair |
7,648 |
7,608 |
$133K |
| E0371 |
Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width |
397 |
397 |
$108K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,927 |
1,904 |
$96K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,969 |
1,955 |
$93K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
998 |
992 |
$87K |
| A4649 |
Surgical supply; miscellaneous |
776 |
743 |
$71K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
996 |
995 |
$50K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,504 |
2,489 |
$38K |
| E0241 |
Bath tub wall rail, each |
1,102 |
1,099 |
$33K |
| A4259 |
Lancets, per box of 100 |
9,460 |
9,447 |
$32K |
| E0156 |
Seat attachment, walker |
2,302 |
2,294 |
$28K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,134 |
1,129 |
$27K |
| A4402 |
Lubricant, per ounce |
4,969 |
4,927 |
$25K |
| E0244 |
Raised toilet seat |
1,464 |
1,460 |
$23K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,290 |
1,275 |
$21K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
1,096 |
1,086 |
$20K |
| B4100 |
Food thickener, administered orally, per ounce |
828 |
819 |
$18K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,544 |
1,520 |
$17K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,193 |
1,168 |
$17K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,821 |
1,819 |
$15K |
| E0243 |
Toilet rail, each |
253 |
252 |
$13K |
| E0607 |
Home blood glucose monitor |
571 |
571 |
$11K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
270 |
263 |
$9K |
| A4245 |
Alcohol wipes, per box |
7,613 |
7,604 |
$9K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
207 |
201 |
$9K |
| A6262 |
Wound filler, dry form, per gram, not otherwise specified |
18 |
17 |
$9K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
138 |
138 |
$9K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
513 |
494 |
$8K |
| E0245 |
Tub stool or bench |
401 |
400 |
$8K |
| E0184 |
Dry pressure mattress |
68 |
68 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,874 |
2,861 |
$8K |
| E0277 |
Powered pressure-reducing air mattress |
75 |
75 |
$7K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
141 |
139 |
$7K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
359 |
356 |
$5K |
| E2603 |
Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
49 |
48 |
$4K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
43 |
43 |
$4K |
| E0570 |
Nebulizer, with compressor |
100 |
100 |
$4K |
| 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 |
42 |
41 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
245 |
237 |
$3K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
252 |
251 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
122 |
112 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
194 |
194 |
$3K |
| E0246 |
Transfer tub rail attachment |
67 |
67 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
39 |
39 |
$2K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
12 |
12 |
$2K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
35 |
30 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
43 |
43 |
$2K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
51 |
51 |
$2K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
13 |
13 |
$1K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
35 |
34 |
$1K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
13 |
13 |
$1K |
| 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 |
14 |
13 |
$1K |
| E0271 |
Mattress, innerspring |
12 |
12 |
$944.84 |
| A4258 |
Spring-powered device for lancet, each |
89 |
89 |
$775.89 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
52 |
52 |
$626.26 |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
13 |
13 |
$439.26 |
| E0215 |
Electric heat pad, moist |
26 |
26 |
$369.98 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
32 |
30 |
$282.82 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
55 |
53 |
$242.08 |
| E0325 |
Urinal; male, jug-type, any material |
12 |
12 |
$24.37 |