| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
2,634 |
2,414 |
$527K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
356 |
343 |
$81K |
| E0245 |
Tub stool or bench |
721 |
689 |
$35K |
| 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 |
71 |
70 |
$31K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
521 |
252 |
$31K |
| E0601 |
Continuous positive airway pressure (cpap) device |
527 |
524 |
$19K |
| A4215 |
Needle, sterile, any size, each |
221 |
214 |
$17K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
549 |
433 |
$12K |
| A4259 |
Lancets, per box of 100 |
334 |
320 |
$10K |
| E0720 |
Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation |
1,902 |
1,572 |
$8K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
166 |
114 |
$6K |
| E0570 |
Nebulizer, with compressor |
202 |
199 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
88 |
87 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
133 |
128 |
$4K |
| E0244 |
Raised toilet seat |
115 |
112 |
$4K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
170 |
167 |
$3K |
| A4670 |
Automatic blood pressure monitor |
33 |
33 |
$2K |
| A4256 |
Normal, low and high calibrator solution / chips |
140 |
132 |
$2K |
| E0241 |
Bath tub wall rail, each |
73 |
65 |
$2K |
| E0156 |
Seat attachment, walker |
98 |
95 |
$2K |
| A9270 |
Non-covered item or service |
170 |
166 |
$1K |
| E1399 |
Durable medical equipment, miscellaneous |
15 |
15 |
$906.89 |
| E0607 |
Home blood glucose monitor |
12 |
12 |
$726.24 |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
15 |
12 |
$557.93 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
15 |
15 |
$532.31 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
67 |
67 |
$241.95 |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
12 |
12 |
$178.14 |
| A7015 |
Aerosol mask, used with dme nebulizer |
69 |
68 |
$106.16 |
| A4245 |
Alcohol wipes, per box |
83 |
79 |
$0.00 |