| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Ef complet w/intact nutrient |
8,926 |
8,346 |
$853K |
| E0260 |
Hosp bed semi-electr w/ matt |
23,712 |
23,436 |
$590K |
| T4527 |
Adult size pull-on lg |
7,590 |
7,177 |
$538K |
| T4541 |
Large disposable underpad |
16,073 |
14,299 |
$531K |
| T4526 |
Adult size pull-on med |
7,087 |
6,740 |
$462K |
| A4353 |
Intermittent urinary cath |
1,325 |
1,142 |
$460K |
| T4528 |
Adult size pull-on xl |
5,388 |
5,063 |
$448K |
| K0001 |
Standard wheelchair |
27,326 |
27,022 |
$424K |
| T4523 |
Adult size brief/diaper lg |
4,543 |
4,099 |
$361K |
| T4535 |
Disposable liner/shield/pad |
8,083 |
7,629 |
$327K |
| A4351 |
Straight tip urine catheter |
2,457 |
2,240 |
$327K |
| A4670 |
Automatic bp monitor, dial |
6,348 |
6,315 |
$321K |
| E0143 |
Walker folding wheeled w/o s |
11,666 |
11,466 |
$283K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,714 |
2,594 |
$261K |
| B4154 |
Ef spec metabolic noninherit |
4,059 |
3,453 |
$240K |
| A4927 |
Non-sterile gloves |
14,958 |
12,554 |
$237K |
| E0245 |
Tub stool or bench |
5,788 |
5,722 |
$217K |
| T4522 |
Adult size brief/diaper med |
2,943 |
2,754 |
$215K |
| T4524 |
Adult size brief/diaper xl |
2,241 |
2,050 |
$207K |
| T4525 |
Adult size pull-on sm |
1,855 |
1,785 |
$170K |
| E0630 |
Patient lift hydraulic |
6,369 |
6,240 |
$164K |
| A6212 |
Foam drg <=16 sq in w/border |
1,474 |
1,181 |
$152K |
| E0265 |
Hosp bed total electr w/ mat |
2,109 |
2,041 |
$142K |
| T4534 |
Youth size pull-on |
1,094 |
1,060 |
$127K |
| A4349 |
Disposable male external cat |
2,544 |
2,164 |
$112K |
| E0277 |
Powered pres-redu air mattrs |
1,009 |
942 |
$110K |
| E0163 |
Commode chair with fixed arm |
3,327 |
3,266 |
$99K |
| T4544 |
Adlt disp und/pull on abv xl |
550 |
536 |
$93K |
| E0570 |
Nebulizer with compression |
9,084 |
8,831 |
$92K |
| T4530 |
Ped size brief/diaper lg |
759 |
739 |
$83K |
| K0003 |
Lightweight wheelchair |
3,319 |
3,272 |
$79K |
| E0244 |
Toilet seat raised |
1,641 |
1,572 |
$77K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
550 |
525 |
$73K |
| K0195 |
Elevating whlchair leg rests |
13,130 |
12,937 |
$71K |
| K0007 |
Extra heavy duty wheelchair |
1,385 |
1,357 |
$63K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,161 |
1,046 |
$58K |
| T4537 |
Reusable underpad bed size |
3,030 |
2,730 |
$54K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
444 |
436 |
$51K |
| A4357 |
Bedside drainage bag |
5,766 |
4,864 |
$48K |
| A4335 |
Incontinence supply |
6,296 |
3,557 |
$48K |
| E0303 |
Hosp bed hvy dty xtra wide |
740 |
724 |
$46K |
| A6260 |
Wound cleanser any type/size |
2,963 |
2,649 |
$45K |
| E0156 |
Walker seat attachment |
6,428 |
6,379 |
$41K |
| K0004 |
High strength ltwt whlchr |
1,590 |
1,579 |
$41K |
| E2601 |
Gen w/c cushion wdth < 22 in |
1,848 |
1,803 |
$40K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
406 |
326 |
$29K |
| E0149 |
Heavy duty wheeled walker |
2,232 |
2,198 |
$27K |
| K0006 |
Heavy duty wheelchair |
751 |
720 |
$26K |
| A9901 |
Delivery/set up/dispensing |
10,621 |
10,075 |
$26K |
| E1038 |
Transport chair pt wt<=300lb |
4,131 |
4,092 |
$25K |
| E0971 |
Wheelchair anti-tipping devi |
11,620 |
6,141 |
$22K |
| E0241 |
Bath tub wall rail |
750 |
722 |
$21K |
| A6216 |
Non-sterile gauze<=16 sq in |
3,851 |
3,327 |
$20K |
| A4649 |
Surgical supplies |
1,638 |
732 |
$19K |
| A4385 |
Ost skn barrier sld ext wear |
397 |
359 |
$18K |
| E0100 |
Cane adjust/fixed with tip |
2,023 |
2,013 |
$18K |
| A4425 |
Ost pch drain for barrier fl |
455 |
402 |
$18K |
| A4409 |
Ost skn barr convex <=4 sq i |
362 |
322 |
$17K |
| E0165 |
Commode chair with detacharm |
2,233 |
2,203 |
$17K |
| T4543 |
Adult disp brief/diap abv xl |
100 |
98 |
$16K |
| E1399 |
Durable medical equipment mi |
895 |
620 |
$16K |
| E0181 |
Press pad alternating w/ pum |
2,797 |
2,715 |
$16K |
| A6197 |
Alginate drsg >16 <=48 sq in |
102 |
89 |
$15K |
| A4358 |
Urinary leg or abdomen bag |
2,314 |
2,084 |
$14K |
| A6250 |
Skin seal protect moisturizr |
2,095 |
1,300 |
$14K |
| E0247 |
Trans bench w/wo comm open |
476 |
436 |
$14K |
| E0261 |
Hosp bed semi-electr w/o mat |
703 |
699 |
$13K |
| A4338 |
Indwelling catheter latex |
1,478 |
1,135 |
$13K |
| A6530 |
Compression stocking bk18-30 |
155 |
148 |
$13K |
| A4402 |
Lubricant per ounce |
2,003 |
1,738 |
$11K |
| A6446 |
Conform band s w>=3" <5"/yd |
614 |
562 |
$10K |
| A4310 |
Insert tray w/o bag/cath |
1,834 |
1,448 |
$10K |
| E0105 |
Cane adjust/fixed quad/3 pro |
442 |
437 |
$9K |
| E1225 |
Manual semi-reclining back |
1,075 |
1,052 |
$9K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
109 |
105 |
$8K |
| A5120 |
Skin barrier, wipe or swab |
1,087 |
915 |
$7K |
| T4521 |
Adult size brief/diaper sm |
94 |
92 |
$7K |
| A4450 |
Non-waterproof tape |
1,803 |
1,561 |
$6K |
| A4352 |
Coude tip urinary catheter |
14 |
12 |
$5K |
| E0168 |
Heavyduty/wide commode chair |
321 |
313 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
794 |
628 |
$5K |
| K0739 |
Repair/svc dme non-oxygen eq |
367 |
348 |
$4K |
| A4432 |
Os pch urine w bar/fange/tap |
158 |
136 |
$4K |
| B4100 |
Food thickener oral |
48 |
39 |
$4K |
| A4322 |
Irrigation syringe |
202 |
171 |
$3K |
| E1031 |
Rollabout chair with casters |
213 |
189 |
$3K |
| A6258 |
Transparent film >16<=48 in |
34 |
34 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
380 |
319 |
$3K |
| E0966 |
Wheelchair head rest extensi |
1,305 |
1,267 |
$3K |
| A5131 |
Appliance cleaner |
165 |
136 |
$2K |
| A4452 |
Waterproof tape |
193 |
147 |
$2K |
| A4331 |
Extension drainage tubing |
527 |
445 |
$2K |
| A5063 |
Drain ostomy pouch w/flange |
26 |
26 |
$966.91 |
| E0184 |
Dry pressure mattress |
26 |
26 |
$965.78 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
73 |
67 |
$811.55 |
| A4344 |
Cath indw foley 2 way silicn |
29 |
25 |
$768.88 |
| A4245 |
Alcohol wipes per box |
366 |
280 |
$722.36 |
| K0056 |
Seat ht <17 or >=21 ltwt wc |
70 |
70 |
$569.97 |
| A4663 |
Dialysis blood pressure cuff |
16 |
16 |
$481.28 |
| A4406 |
Pectin based ostomy paste |
53 |
48 |
$434.97 |
| A4657 |
Syringe w/wo needle |
44 |
42 |
$419.80 |
| E0325 |
Urinal male jug-type |
30 |
29 |
$340.06 |
| A7003 |
Nebulizer administration set |
274 |
267 |
$322.63 |
| E0910 |
Trapeze bar attached to bed |
42 |
42 |
$161.74 |
| A7015 |
Aerosol mask used w nebulize |
77 |
76 |
$69.57 |
| 90662 |
|
88 |
88 |
$0.00 |
| 90674 |
|
43 |
43 |
$0.00 |
| 0134A |
|
34 |
34 |
$0.00 |
| G0008 |
Admin influenza virus vac |
141 |
141 |
$0.00 |
| 0064A |
|
31 |
31 |
$0.00 |