| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
31,252 |
31,187 |
$2.27M |
| A4554 |
Disposable underpads, all sizes |
59,718 |
59,590 |
$2.24M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
60,035 |
59,899 |
$1.86M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
13,404 |
13,384 |
$1.01M |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
31,822 |
31,722 |
$868K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
8,700 |
4,939 |
$528K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
8,815 |
8,795 |
$488K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
14,053 |
14,001 |
$408K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,502 |
2,502 |
$334K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
6,336 |
3,588 |
$258K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
3,278 |
1,835 |
$156K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
1,473 |
1,472 |
$144K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
5,714 |
5,688 |
$97K |
| 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 |
3,325 |
2,208 |
$87K |
| A4927 |
Gloves, non-sterile, per 100 |
14,760 |
14,672 |
$76K |
| 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 |
3,271 |
2,182 |
$68K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,220 |
1,309 |
$60K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
311 |
311 |
$12K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
125 |
78 |
$9K |
| E0156 |
Seat attachment, walker |
327 |
326 |
$7K |
| A4670 |
Automatic blood pressure monitor |
169 |
167 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
236 |
236 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
298 |
297 |
$4K |
| K0001 |
Standard wheelchair |
995 |
982 |
$4K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
33 |
17 |
$3K |
| A4335 |
Incontinence supply; miscellaneous |
345 |
344 |
$2K |
| E1399 |
Durable medical equipment, miscellaneous |
224 |
223 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
25 |
25 |
$942.90 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
520 |
518 |
$730.32 |
| 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 |
12 |
12 |
$655.14 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
41 |
41 |
$369.26 |
| E0241 |
Bath tub wall rail, each |
12 |
12 |
$321.32 |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$8.40 |