| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
334,757 |
72,998 |
$6.13M |
| 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 |
32,727 |
8,375 |
$3.03M |
| 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 |
42,733 |
11,095 |
$3.02M |
| 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 |
15,915 |
3,904 |
$1.42M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
21,362 |
19,294 |
$1.14M |
| A4554 |
Disposable underpads, all sizes |
13,663 |
12,932 |
$832K |
| A4335 |
Incontinence supply; miscellaneous |
40,500 |
38,324 |
$550K |
| A4927 |
Gloves, non-sterile, per 100 |
25,446 |
22,511 |
$426K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,200 |
5,973 |
$355K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
20,799 |
16,430 |
$225K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,617 |
2,571 |
$219K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,780 |
2,652 |
$166K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,760 |
2,748 |
$108K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
2,791 |
2,706 |
$99K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,706 |
1,599 |
$90K |
| E0244 |
Raised toilet seat |
1,531 |
1,514 |
$73K |
| A9270 |
Non-covered item or service |
8,851 |
7,927 |
$73K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
572 |
234 |
$65K |
| A4466 |
Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each |
2,631 |
2,417 |
$57K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
2,077 |
2,066 |
$56K |
| E0245 |
Tub stool or bench |
1,487 |
1,477 |
$56K |
| E0241 |
Bath tub wall rail, each |
2,410 |
1,979 |
$51K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
2,277 |
1,967 |
$49K |
| 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 |
1,879 |
1,840 |
$49K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,218 |
1,078 |
$41K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
321 |
321 |
$24K |
| A4245 |
Alcohol wipes, per box |
3,434 |
3,428 |
$22K |
| K0002 |
Standard hemi (low seat) wheelchair |
148 |
148 |
$21K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,846 |
1,822 |
$20K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
224 |
206 |
$20K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
451 |
450 |
$18K |
| A6413 |
Adhesive bandage, first-aid type, any size, each |
1,708 |
1,704 |
$14K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
1,318 |
1,317 |
$13K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
137 |
136 |
$12K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
733 |
733 |
$11K |
| E0243 |
Toilet rail, each |
202 |
201 |
$8K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
374 |
371 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
833 |
825 |
$4K |
| A4452 |
Tape, waterproof, per 18 square inches |
536 |
536 |
$4K |
| L3923 |
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
312 |
312 |
$3K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
998 |
781 |
$3K |
| A4649 |
Surgical supply; miscellaneous |
876 |
747 |
$3K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
477 |
475 |
$2K |
| E0325 |
Urinal; male, jug-type, any material |
147 |
145 |
$620.00 |