| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
11,845 |
11,639 |
$342K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
10,958 |
10,222 |
$242K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,679 |
3,544 |
$186K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,727 |
2,675 |
$182K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,980 |
1,627 |
$143K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,832 |
2,662 |
$110K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
181 |
180 |
$100K |
| E1399 |
Durable medical equipment, miscellaneous |
972 |
915 |
$83K |
| E0570 |
Nebulizer, with compressor |
864 |
858 |
$83K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
614 |
608 |
$71K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
602 |
601 |
$71K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
2,840 |
2,576 |
$63K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
3,001 |
2,735 |
$59K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,244 |
1,173 |
$53K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
694 |
620 |
$51K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,181 |
1,101 |
$44K |
| A4927 |
Gloves, non-sterile, per 100 |
6,625 |
6,448 |
$33K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
578 |
569 |
$32K |
| 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 |
394 |
393 |
$28K |
| 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 |
230 |
228 |
$28K |
| E0652 |
Pneumatic compressor, segmental home model with calibrated gradient pressure |
16 |
16 |
$26K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
894 |
893 |
$23K |
| E0241 |
Bath tub wall rail, each |
617 |
614 |
$23K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
42 |
42 |
$20K |
| E0601 |
Continuous positive airway pressure (cpap) device |
478 |
478 |
$19K |
| 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 |
196 |
192 |
$16K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
554 |
553 |
$14K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
34 |
32 |
$13K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
99 |
99 |
$13K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
283 |
258 |
$13K |
| E0243 |
Toilet rail, each |
231 |
231 |
$12K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
621 |
612 |
$11K |
| A4670 |
Automatic blood pressure monitor |
162 |
162 |
$11K |
| A7030 |
Full face mask used with positive airway pressure device, each |
127 |
127 |
$10K |
| A7031 |
Face mask interface, replacement for full face mask, each |
118 |
118 |
$9K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
127 |
127 |
$8K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
102 |
102 |
$6K |
| A4259 |
Lancets, per box of 100 |
678 |
610 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
50 |
50 |
$6K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
141 |
141 |
$5K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
27 |
26 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
276 |
276 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
78 |
78 |
$3K |
| K0001 |
Standard wheelchair |
151 |
151 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
189 |
189 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
231 |
231 |
$2K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
25 |
24 |
$2K |
| E0244 |
Raised toilet seat |
128 |
128 |
$2K |
| A4335 |
Incontinence supply; miscellaneous |
157 |
61 |
$2K |
| A4245 |
Alcohol wipes, per box |
621 |
601 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
241 |
241 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
29 |
28 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
28 |
28 |
$1K |
| E0607 |
Home blood glucose monitor |
19 |
14 |
$995.54 |
| A5120 |
Skin barrier, wipes or swabs, each |
210 |
200 |
$928.30 |
| A4456 |
Adhesive remover, wipes, any type, each |
100 |
95 |
$776.26 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
40 |
37 |
$766.16 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
28 |
26 |
$678.90 |
| A7015 |
Aerosol mask, used with dme nebulizer |
641 |
639 |
$674.94 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
61 |
61 |
$533.82 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
43 |
43 |
$401.41 |
| B4100 |
Food thickener, administered orally, per ounce |
16 |
16 |
$400.68 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
13 |
13 |
$176.88 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$174.32 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
66 |
66 |
$124.83 |
| A7000 |
Canister, disposable, used with suction pump, each |
12 |
12 |
$97.18 |
| A4371 |
Ostomy skin barrier, powder, per oz |
13 |
13 |
$47.72 |
| A4402 |
Lubricant, per ounce |
16 |
16 |
$30.20 |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
17 |
17 |
$0.00 |