| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
153,028 |
142,150 |
$5.58M |
| 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 |
48,748 |
37,570 |
$4.97M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
134,168 |
124,939 |
$4.92M |
| 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 |
67,977 |
50,598 |
$4.34M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
61,283 |
56,475 |
$4.01M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
18,707 |
17,546 |
$3.29M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
45,663 |
42,370 |
$3.28M |
| A4927 |
Gloves, non-sterile, per 100 |
213,054 |
197,918 |
$3.13M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
45,722 |
42,580 |
$2.72M |
| 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 |
30,339 |
22,043 |
$2.45M |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
36,875 |
24,380 |
$2.30M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
21,124 |
19,716 |
$2.15M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
6,076 |
5,575 |
$1.12M |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
17,953 |
16,771 |
$910K |
| 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 |
5,817 |
5,367 |
$814K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,360 |
7,431 |
$605K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,939 |
6,169 |
$565K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
7,327 |
6,293 |
$518K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
8,415 |
7,747 |
$454K |
| 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 |
2,886 |
2,688 |
$364K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
7,437 |
5,387 |
$351K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
6,824 |
6,424 |
$332K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,321 |
2,937 |
$332K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
15,736 |
14,816 |
$294K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
4,873 |
4,548 |
$274K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
11,587 |
10,399 |
$269K |
| A4670 |
Automatic blood pressure monitor |
6,544 |
6,122 |
$251K |
| L3650 |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
7,089 |
6,609 |
$249K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
3,439 |
2,988 |
$236K |
| E0245 |
Tub stool or bench |
5,918 |
5,578 |
$185K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
5,401 |
4,702 |
$181K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
4,102 |
3,813 |
$164K |
| E0244 |
Raised toilet seat |
3,676 |
3,444 |
$148K |
| B9998 |
Noc for enteral supplies |
2,421 |
1,527 |
$127K |
| 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 |
1,111 |
729 |
$109K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,939 |
2,240 |
$96K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,751 |
1,193 |
$94K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,485 |
2,153 |
$89K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
1,100 |
1,019 |
$83K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,113 |
1,034 |
$81K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
3,316 |
2,989 |
$76K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
944 |
853 |
$71K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,564 |
1,417 |
$59K |
| E0627 |
Seat lift mechanism, electric, any type |
1,234 |
1,012 |
$47K |
| E0246 |
Transfer tub rail attachment |
1,018 |
971 |
$47K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
1,174 |
769 |
$46K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
279 |
251 |
$45K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
3,517 |
3,072 |
$45K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
324 |
255 |
$44K |
| E0156 |
Seat attachment, walker |
7,377 |
6,608 |
$41K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
785 |
687 |
$40K |
| E0241 |
Bath tub wall rail, each |
1,869 |
1,701 |
$38K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
93 |
86 |
$31K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
1,912 |
1,569 |
$30K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,169 |
947 |
$28K |
| E0243 |
Toilet rail, each |
880 |
828 |
$28K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,193 |
1,088 |
$27K |
| A7035 |
Headgear used with positive airway pressure device |
1,918 |
1,748 |
$27K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,081 |
972 |
$25K |
| 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 |
317 |
272 |
$24K |
| A4570 |
Splint |
3,089 |
2,875 |
$24K |
| A7037 |
Tubing used with positive airway pressure device |
2,547 |
2,320 |
$24K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,003 |
794 |
$23K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
200 |
179 |
$20K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,275 |
1,132 |
$18K |
| K0003 |
Lightweight wheelchair |
574 |
458 |
$17K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
510 |
401 |
$16K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
2,195 |
1,946 |
$15K |
| A7526 |
Tracheostomy tube collar/holder, each |
769 |
631 |
$14K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,192 |
2,358 |
$12K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,756 |
1,550 |
$11K |
| E0601 |
Continuous positive airway pressure (cpap) device |
729 |
585 |
$10K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,512 |
3,010 |
$10K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,851 |
1,711 |
$10K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
365 |
330 |
$10K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,245 |
986 |
$10K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,315 |
1,171 |
$10K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
97 |
83 |
$10K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,248 |
4,055 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,006 |
2,640 |
$9K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
468 |
427 |
$9K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
954 |
811 |
$9K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,926 |
1,642 |
$9K |
| E1392 |
Portable oxygen concentrator, rental |
409 |
379 |
$9K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
510 |
452 |
$8K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
334 |
290 |
$8K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
120 |
94 |
$8K |
| E0570 |
Nebulizer, with compressor |
880 |
755 |
$8K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,352 |
2,010 |
$7K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
366 |
332 |
$7K |
| B4100 |
Food thickener, administered orally, per ounce |
258 |
193 |
$7K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
269 |
241 |
$7K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
964 |
868 |
$5K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
396 |
350 |
$5K |
| 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) |
189 |
148 |
$5K |
| A4402 |
Lubricant, per ounce |
1,589 |
1,408 |
$4K |
| A4452 |
Tape, waterproof, per 18 square inches |
168 |
148 |
$4K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
244 |
189 |
$3K |
| A4623 |
Tracheostomy, inner cannula |
137 |
105 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
734 |
591 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,673 |
1,864 |
$3K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
90 |
81 |
$3K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
279 |
251 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
227 |
184 |
$2K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
69 |
50 |
$2K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, 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 padding, 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 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
216 |
167 |
$2K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
32 |
27 |
$2K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
62 |
54 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
455 |
397 |
$1K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
186 |
148 |
$1K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
13 |
13 |
$902.36 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
371 |
271 |
$750.20 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
80 |
63 |
$589.24 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
274 |
249 |
$504.17 |
| L8020 |
Breast prosthesis, mastectomy form |
31 |
26 |
$502.97 |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
12 |
12 |
$492.30 |
| E0148 |
Walker, heavy duty, without wheels, rigid or folding, any type, each |
13 |
12 |
$487.18 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
164 |
130 |
$440.57 |
| A7036 |
Chinstrap used with positive airway pressure device |
59 |
54 |
$421.08 |
| K0001 |
Standard wheelchair |
12 |
12 |
$389.66 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
252 |
194 |
$358.08 |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
29 |
25 |
$343.54 |
| L0120 |
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) |
25 |
24 |
$295.11 |
| A4332 |
Lubricant, individual sterile packet, each |
94 |
64 |
$261.93 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
25 |
24 |
$134.97 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
66 |
60 |
$105.00 |
| L3260 |
Surgical boot/shoe, each |
47 |
26 |
$104.69 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
297 |
272 |
$35.99 |