| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
34,609 |
33,338 |
$1.18M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,765 |
8,429 |
$884K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,105 |
8,722 |
$859K |
| 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 |
8,342 |
7,415 |
$761K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
6,742 |
6,498 |
$747K |
| A4927 |
Gloves, non-sterile, per 100 |
46,802 |
45,100 |
$670K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,654 |
2,529 |
$644K |
| 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 |
4,665 |
4,152 |
$633K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,975 |
12,412 |
$492K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,882 |
4,687 |
$464K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,193 |
2,081 |
$418K |
| 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 |
3,571 |
3,095 |
$416K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,652 |
2,546 |
$305K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,153 |
3,028 |
$294K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,655 |
2,494 |
$273K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,117 |
1,959 |
$206K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
4,115 |
3,940 |
$195K |
| E0144 |
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
1,609 |
1,507 |
$165K |
| E0570 |
Nebulizer, with compressor |
1,707 |
1,620 |
$133K |
| A4670 |
Automatic blood pressure monitor |
4,011 |
3,840 |
$131K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
1,822 |
1,762 |
$125K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,803 |
1,729 |
$122K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
5,931 |
5,885 |
$102K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,218 |
1,924 |
$97K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,617 |
1,328 |
$44K |
| E0245 |
Tub stool or bench |
1,414 |
1,364 |
$43K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
887 |
842 |
$35K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
247 |
193 |
$26K |
| 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 |
890 |
519 |
$21K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
489 |
451 |
$17K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,945 |
1,856 |
$15K |
| 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 |
295 |
272 |
$13K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
215 |
208 |
$11K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
150 |
146 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,094 |
1,013 |
$10K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
89 |
83 |
$9K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
165 |
133 |
$8K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
918 |
841 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
838 |
806 |
$6K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
765 |
739 |
$5K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
200 |
191 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,330 |
1,197 |
$4K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
76 |
76 |
$4K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
641 |
552 |
$3K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
679 |
599 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
152 |
145 |
$3K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
25 |
25 |
$3K |
| 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 |
242 |
138 |
$3K |
| L0628 |
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
55 |
53 |
$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 |
129 |
80 |
$2K |
| 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 |
81 |
41 |
$2K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
56 |
54 |
$1K |
| A4402 |
Lubricant, per ounce |
500 |
472 |
$1K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
12 |
12 |
$1K |
| E0244 |
Raised toilet seat |
24 |
24 |
$911.10 |
| A5120 |
Skin barrier, wipes or swabs, each |
176 |
169 |
$838.62 |
| L0630 |
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
12 |
12 |
$587.40 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
36 |
36 |
$476.17 |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
53 |
52 |
$399.63 |
| E0156 |
Seat attachment, walker |
78 |
75 |
$363.83 |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
16 |
14 |
$363.60 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
12 |
12 |
$363.28 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
85 |
84 |
$138.11 |
| A4259 |
Lancets, per box of 100 |
189 |
172 |
$61.98 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
12 |
12 |
$61.90 |