| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
31,585 |
31,098 |
$3.13M |
| T4541 |
Incontinence product, disposable underpad, large, each |
14,874 |
14,571 |
$926K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
13,152 |
12,938 |
$565K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,646 |
4,574 |
$462K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,056 |
2,010 |
$283K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,811 |
1,748 |
$183K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
350 |
337 |
$84K |
| A4927 |
Gloves, non-sterile, per 100 |
7,522 |
7,194 |
$69K |
| A6534 |
Gradient compression stocking, thigh length, 30-40 mmhg, each |
549 |
542 |
$56K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
770 |
766 |
$32K |
| 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 |
293 |
286 |
$27K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, 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 pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
668 |
641 |
$25K |
| A4670 |
Automatic blood pressure monitor |
376 |
367 |
$22K |
| K0003 |
Lightweight wheelchair |
433 |
422 |
$12K |
| 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 |
317 |
273 |
$10K |
| 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 |
317 |
273 |
$9K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
130 |
129 |
$5K |
| E0243 |
Toilet rail, each |
76 |
76 |
$2K |
| E0244 |
Raised toilet seat |
53 |
53 |
$1K |
| E0156 |
Seat attachment, walker |
125 |
124 |
$936.93 |
| E0210 |
Electric heat pad, standard |
43 |
42 |
$572.44 |