| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,389 |
6,113 |
$639K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
13,439 |
11,499 |
$587K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,818 |
5,598 |
$483K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,047 |
6,255 |
$399K |
| T4541 |
Incontinence product, disposable underpad, large, each |
8,851 |
8,579 |
$362K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,804 |
4,354 |
$360K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,910 |
1,808 |
$341K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,525 |
3,326 |
$339K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
9,040 |
8,797 |
$317K |
| A4927 |
Gloves, non-sterile, per 100 |
20,536 |
19,831 |
$289K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,443 |
5,094 |
$205K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
6,827 |
6,241 |
$194K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,293 |
1,183 |
$188K |
| E0570 |
Nebulizer, with compressor |
8,325 |
7,339 |
$180K |
| S9999 |
Sales tax |
12,727 |
11,560 |
$146K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,296 |
1,182 |
$145K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,685 |
2,467 |
$135K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,543 |
1,481 |
$130K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,352 |
1,321 |
$128K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,585 |
1,328 |
$119K |
| A7035 |
Headgear used with positive airway pressure device |
5,841 |
5,392 |
$110K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,464 |
1,384 |
$107K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
923 |
780 |
$105K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,425 |
1,401 |
$98K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
892 |
860 |
$95K |
| K0004 |
High strength, lightweight wheelchair |
3,263 |
2,805 |
$84K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
9,643 |
8,385 |
$80K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,234 |
1,201 |
$76K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,635 |
3,183 |
$69K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,770 |
2,416 |
$59K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
953 |
932 |
$59K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,825 |
1,615 |
$54K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,437 |
8,672 |
$50K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,724 |
895 |
$48K |
| K0002 |
Standard hemi (low seat) wheelchair |
2,423 |
2,095 |
$42K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
451 |
411 |
$38K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,975 |
1,834 |
$37K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,493 |
3,219 |
$32K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
403 |
360 |
$25K |
| 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 |
498 |
349 |
$24K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,287 |
909 |
$23K |
| A4670 |
Automatic blood pressure monitor |
365 |
343 |
$22K |
| K0001 |
Standard wheelchair |
1,321 |
1,163 |
$17K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,154 |
575 |
$15K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
117 |
93 |
$15K |
| E0156 |
Seat attachment, walker |
1,401 |
1,265 |
$12K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
454 |
371 |
$10K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
331 |
302 |
$10K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
974 |
479 |
$7K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
181 |
174 |
$7K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
42 |
41 |
$6K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
356 |
312 |
$6K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
644 |
566 |
$6K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,137 |
568 |
$6K |
| 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 |
235 |
153 |
$6K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
365 |
314 |
$5K |
| K0003 |
Lightweight wheelchair |
191 |
164 |
$4K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
41 |
41 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
403 |
365 |
$3K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
361 |
334 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
328 |
292 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
140 |
121 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
41 |
30 |
$2K |
| A4402 |
Lubricant, per ounce |
280 |
246 |
$2K |
| K0007 |
Extra heavy duty wheelchair |
56 |
51 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
85 |
78 |
$2K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
42 |
37 |
$2K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, 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 |
33 |
27 |
$2K |
| E1399 |
Durable medical equipment, miscellaneous |
15 |
15 |
$671.17 |
| K0006 |
Heavy duty wheelchair |
34 |
26 |
$641.86 |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
12 |
12 |
$630.77 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
15 |
14 |
$601.69 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
25 |
24 |
$588.68 |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
28 |
24 |
$497.40 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
12 |
12 |
$322.21 |
| A7037 |
Tubing used with positive airway pressure device |
17 |
13 |
$178.62 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
26 |
24 |
$73.66 |
| A5120 |
Skin barrier, wipes or swabs, each |
12 |
12 |
$70.63 |