| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
17,013 |
15,373 |
$405K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,575 |
6,977 |
$383K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
6,470 |
6,058 |
$278K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,393 |
4,092 |
$271K |
| A4245 |
Alcohol wipes, per box |
20,307 |
19,430 |
$162K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,544 |
3,141 |
$128K |
| A4927 |
Gloves, non-sterile, per 100 |
17,458 |
16,701 |
$126K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,943 |
1,621 |
$119K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
953 |
852 |
$107K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
145 |
130 |
$99K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,121 |
1,064 |
$94K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
261 |
227 |
$84K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
304 |
289 |
$82K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,554 |
1,338 |
$75K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
91 |
85 |
$74K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,507 |
1,433 |
$69K |
| A6023 |
Collagen dressing, sterile, size more than 48 sq. in., each |
26 |
24 |
$63K |
| A4335 |
Incontinence supply; miscellaneous |
1,826 |
1,553 |
$55K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
272 |
242 |
$35K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
812 |
730 |
$34K |
| S5199 |
Personal care item, nos, each |
1,094 |
635 |
$19K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
119 |
91 |
$18K |
| K0001 |
Standard wheelchair |
796 |
722 |
$17K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
111 |
90 |
$15K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,197 |
3,117 |
$14K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
229 |
212 |
$12K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,578 |
1,230 |
$10K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
66 |
63 |
$7K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
37 |
36 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
165 |
141 |
$7K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
13 |
12 |
$7K |
| K0003 |
Lightweight wheelchair |
470 |
308 |
$6K |
| B9002 |
Enteral nutrition infusion pump, any type |
86 |
80 |
$5K |
| K0007 |
Extra heavy duty wheelchair |
43 |
40 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
274 |
273 |
$4K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
16 |
14 |
$3K |
| A4452 |
Tape, waterproof, per 18 square inches |
81 |
70 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
229 |
216 |
$3K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
17 |
12 |
$3K |
| E0974 |
Manual wheelchair accessory, anti-rollback device, each |
78 |
50 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
316 |
258 |
$3K |
| 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 |
368 |
101 |
$2K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
89 |
83 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
52 |
51 |
$2K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
631 |
402 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
62 |
62 |
$2K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
121 |
67 |
$2K |
| E0156 |
Seat attachment, walker |
175 |
152 |
$1K |
| 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 |
331 |
101 |
$1K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
25 |
25 |
$632.65 |
| A4259 |
Lancets, per box of 100 |
53 |
52 |
$407.16 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
31 |
24 |
$262.26 |