| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
28,388 |
27,436 |
$1.96M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
9,110 |
8,882 |
$1.07M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
8,688 |
8,439 |
$816K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
5,871 |
5,661 |
$787K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
20,021 |
19,302 |
$645K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,873 |
2,759 |
$450K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
11,142 |
10,652 |
$346K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
17,694 |
17,009 |
$308K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,715 |
3,547 |
$300K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,983 |
5,929 |
$222K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,237 |
2,181 |
$217K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
844 |
826 |
$181K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, 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 padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
654 |
646 |
$118K |
| A4927 |
Gloves, non-sterile, per 100 |
25,118 |
24,234 |
$110K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
2,418 |
2,386 |
$100K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
1,652 |
1,635 |
$68K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
299 |
290 |
$45K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
259 |
251 |
$16K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
208 |
207 |
$12K |
| A4335 |
Incontinence supply; miscellaneous |
2,092 |
2,092 |
$11K |
| A4402 |
Lubricant, per ounce |
1,621 |
1,618 |
$7K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
614 |
613 |
$7K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
204 |
203 |
$3K |
| E1399 |
Durable medical equipment, miscellaneous |
215 |
215 |
$3K |
| E0144 |
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
14 |
14 |
$2K |
| A4670 |
Automatic blood pressure monitor |
37 |
37 |
$2K |
| K0001 |
Standard wheelchair |
40 |
39 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
16 |
14 |
$614.19 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
13 |
13 |
$448.61 |
| E0156 |
Seat attachment, walker |
17 |
15 |
$164.10 |