| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,884 |
1,715 |
$450K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,096 |
1,054 |
$270K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
3,748 |
3,396 |
$268K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
858 |
830 |
$204K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
8,521 |
7,203 |
$198K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
982 |
910 |
$137K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,429 |
1,371 |
$134K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
153 |
144 |
$129K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,061 |
2,000 |
$80K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,902 |
1,842 |
$76K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
627 |
572 |
$72K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,087 |
1,037 |
$57K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,033 |
982 |
$53K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
934 |
870 |
$47K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
299 |
291 |
$44K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
855 |
782 |
$40K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
322 |
299 |
$37K |
| A7035 |
Headgear used with positive airway pressure device |
1,834 |
1,757 |
$36K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
722 |
671 |
$34K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,334 |
7,023 |
$33K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
264 |
251 |
$31K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,494 |
1,425 |
$30K |
| E0570 |
Nebulizer, with compressor |
856 |
816 |
$28K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
98 |
87 |
$28K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
484 |
449 |
$26K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
378 |
358 |
$22K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
321 |
299 |
$20K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
309 |
278 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
657 |
619 |
$19K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
193 |
172 |
$17K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,601 |
1,515 |
$15K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
232 |
211 |
$14K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
399 |
371 |
$14K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
564 |
512 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
742 |
697 |
$12K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
57 |
53 |
$11K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
949 |
907 |
$11K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
186 |
163 |
$10K |
| A4452 |
Tape, waterproof, per 18 square inches |
389 |
354 |
$9K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
120 |
111 |
$9K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
765 |
668 |
$8K |
| T4541 |
Incontinence product, disposable underpad, large, each |
206 |
172 |
$7K |
| A4402 |
Lubricant, per ounce |
681 |
640 |
$7K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
561 |
524 |
$6K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
182 |
173 |
$4K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
162 |
159 |
$4K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
50 |
48 |
$4K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
57 |
55 |
$3K |
| A4367 |
Ostomy belt, each |
443 |
431 |
$3K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
28 |
28 |
$3K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
303 |
282 |
$3K |
| A4371 |
Ostomy skin barrier, powder, per oz |
656 |
612 |
$3K |
| 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 |
62 |
54 |
$2K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
25 |
25 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
86 |
81 |
$2K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
559 |
544 |
$2K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
104 |
94 |
$2K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
107 |
102 |
$2K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
70 |
66 |
$2K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
125 |
120 |
$1K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
12 |
12 |
$923.50 |
| A4670 |
Automatic blood pressure monitor |
14 |
13 |
$901.82 |
| A5120 |
Skin barrier, wipes or swabs, each |
124 |
122 |
$817.90 |
| E1399 |
Durable medical equipment, miscellaneous |
13 |
12 |
$773.09 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
12 |
12 |
$455.87 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
28 |
24 |
$58.76 |
| E0601 |
Continuous positive airway pressure (cpap) device |
66 |
61 |
$0.00 |