| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
2,975 |
2,530 |
$1.57M |
| A4554 |
Disposable underpads, all sizes |
36,925 |
36,690 |
$1.30M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
10,691 |
10,574 |
$1.11M |
| 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 |
1,698 |
1,630 |
$803K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,768 |
5,689 |
$779K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
23,955 |
22,720 |
$773K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
8,983 |
8,931 |
$757K |
| 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 |
2,420 |
2,379 |
$433K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,693 |
1,647 |
$357K |
| A4335 |
Incontinence supply; miscellaneous |
42,930 |
42,502 |
$244K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
681 |
665 |
$151K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,182 |
3,144 |
$129K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,764 |
1,753 |
$128K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,084 |
1,075 |
$96K |
| K0003 |
Lightweight wheelchair |
3,096 |
3,054 |
$90K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
673 |
672 |
$86K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
774 |
768 |
$69K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,346 |
2,244 |
$59K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
381 |
370 |
$49K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
158 |
80 |
$43K |
| A4670 |
Automatic blood pressure monitor |
686 |
684 |
$40K |
| A4927 |
Gloves, non-sterile, per 100 |
3,226 |
3,181 |
$24K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
584 |
568 |
$21K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,355 |
2,301 |
$18K |
| E0627 |
Seat lift mechanism, electric, any type |
145 |
139 |
$12K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
1,725 |
1,705 |
$11K |
| A4259 |
Lancets, per box of 100 |
2,064 |
2,047 |
$11K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
267 |
263 |
$10K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
206 |
189 |
$8K |
| E0570 |
Nebulizer, with compressor |
563 |
563 |
$5K |
| A4245 |
Alcohol wipes, per box |
1,222 |
1,212 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
99 |
58 |
$1K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
44 |
43 |
$967.67 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
57 |
56 |
$940.84 |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
12 |
12 |
$776.35 |
| E0156 |
Seat attachment, walker |
268 |
262 |
$662.73 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
39 |
39 |
$40.81 |
| A4256 |
Normal, low and high calibrator solution / chips |
14 |
13 |
$25.83 |
| A7015 |
Aerosol mask, used with dme nebulizer |
40 |
40 |
$25.43 |
| A4258 |
Spring-powered device for lancet, each |
18 |
17 |
$17.88 |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
14 |
14 |
$0.00 |
| 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 |
32 |
32 |
$0.00 |
| E0607 |
Home blood glucose monitor |
18 |
17 |
$0.00 |