| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4670 |
Automatic blood pressure monitor |
2,313 |
2,213 |
$222K |
| A4554 |
Disposable underpads, all sizes |
4,578 |
3,406 |
$161K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,140 |
1,068 |
$128K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,627 |
1,542 |
$112K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
984 |
933 |
$101K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
755 |
700 |
$58K |
| A4927 |
Gloves, non-sterile, per 100 |
3,607 |
2,529 |
$27K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
602 |
448 |
$26K |
| E0570 |
Nebulizer, with compressor |
68 |
67 |
$19K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
760 |
602 |
$17K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
310 |
278 |
$15K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
732 |
493 |
$15K |
| A4245 |
Alcohol wipes, per box |
1,413 |
945 |
$7K |
| E0144 |
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
33 |
25 |
$6K |
| A5120 |
Skin barrier, wipes or swabs, each |
672 |
538 |
$3K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
69 |
40 |
$3K |
| E0245 |
Tub stool or bench |
39 |
34 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,479 |
1,903 |
$2K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
26 |
25 |
$2K |
| 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 |
13 |
13 |
$2K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
19 |
15 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
68 |
67 |
$1K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
13 |
12 |
$929.88 |
| A4259 |
Lancets, per box of 100 |
2,106 |
1,717 |
$926.44 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
19 |
12 |
$864.60 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
74 |
57 |
$754.83 |
| A4217 |
Sterile water/saline, 500 ml |
127 |
99 |
$628.69 |
| A4456 |
Adhesive remover, wipes, any type, each |
64 |
50 |
$397.63 |
| A6260 |
Wound cleansers, any type, any size |
12 |
12 |
$192.45 |
| A4452 |
Tape, waterproof, per 18 square inches |
63 |
54 |
$88.33 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
13 |
12 |
$73.85 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
3,682 |
2,303 |
$0.00 |