| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
2,861 |
2,659 |
$215K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,219 |
1,065 |
$182K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
5,768 |
5,023 |
$170K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,210 |
2,050 |
$154K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
958 |
908 |
$139K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
2,386 |
2,146 |
$130K |
| E0570 |
Nebulizer, with compressor |
3,553 |
2,803 |
$126K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
865 |
809 |
$126K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
2,201 |
1,849 |
$125K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
1,799 |
1,535 |
$109K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
2,170 |
1,852 |
$103K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
5,808 |
4,223 |
$101K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
829 |
724 |
$95K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,149 |
1,799 |
$79K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
503 |
479 |
$72K |
| A4927 |
Gloves, non-sterile, per 100 |
2,899 |
2,716 |
$64K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
431 |
403 |
$55K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
330 |
285 |
$53K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
391 |
371 |
$50K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
205 |
197 |
$49K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
340 |
280 |
$39K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
414 |
378 |
$37K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,343 |
2,095 |
$36K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
119 |
115 |
$30K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
218 |
193 |
$26K |
| L3260 |
Surgical boot/shoe, each |
2,378 |
1,863 |
$26K |
| E0245 |
Tub stool or bench |
358 |
310 |
$23K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
198 |
181 |
$21K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,897 |
1,463 |
$19K |
| E0241 |
Bath tub wall rail, each |
204 |
158 |
$12K |
| K0001 |
Standard wheelchair |
1,547 |
1,413 |
$10K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
676 |
585 |
$10K |
| A9281 |
Reaching/grabbing device, any type, any length, each |
166 |
143 |
$8K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
356 |
317 |
$7K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,350 |
1,284 |
$6K |
| E0244 |
Raised toilet seat |
152 |
110 |
$6K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
187 |
170 |
$4K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,950 |
1,754 |
$3K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
235 |
219 |
$3K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
136 |
127 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
41 |
38 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$2K |
| E0242 |
Bath tub rail, floor base |
15 |
13 |
$1K |
| E0156 |
Seat attachment, walker |
204 |
152 |
$1K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
13 |
13 |
$833.56 |
| L3650 |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
12 |
12 |
$547.32 |
| E0676 |
Intermittent limb compression device (includes all accessories), not otherwise specified |
114 |
111 |
$425.00 |
| K0006 |
Heavy duty wheelchair |
14 |
14 |
$288.58 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
76 |
64 |
$250.45 |