| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A8003 |
Helmet, protective, hard, custom fabricated, includes all components and accessories |
1,199 |
1,114 |
$468K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
5,610 |
5,291 |
$115K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
5,255 |
4,101 |
$58K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
938 |
594 |
$39K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
269 |
201 |
$26K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
212 |
155 |
$22K |
| E0607 |
Home blood glucose monitor |
601 |
323 |
$17K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,699 |
1,072 |
$12K |
| L8624 |
Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each |
114 |
87 |
$11K |
| B9998 |
Noc for enteral supplies |
395 |
318 |
$10K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
160 |
103 |
$10K |
| L2280 |
Addition to lower extremity, molded inner boot |
44 |
32 |
$8K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
399 |
306 |
$7K |
| A4259 |
Lancets, per box of 100 |
1,062 |
611 |
$7K |
| A4322 |
Irrigation syringe, bulb or piston, each |
224 |
149 |
$3K |
| V5140 |
Binaural, behind the ear |
15 |
12 |
$3K |
| B4082 |
Nasogastric tubing without stylet |
305 |
179 |
$2K |
| A4670 |
Automatic blood pressure monitor |
294 |
263 |
$2K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
36 |
25 |
$2K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
26 |
15 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
126 |
95 |
$1K |
| V5060 |
Hearing aid, monaural, behind the ear |
17 |
17 |
$1K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
19 |
15 |
$687.23 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
408 |
306 |
$651.93 |
| E0480 |
Percussor, electric or pneumatic, home model |
1,146 |
828 |
$565.86 |
| V5267 |
Hearing aid or assistive listening device/supplies/accessories, not otherwise specified |
42 |
38 |
$393.94 |
| A7526 |
Tracheostomy tube collar/holder, each |
19 |
13 |
$292.00 |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
110 |
84 |
$236.89 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
35 |
14 |
$175.56 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
128 |
110 |
$46.04 |
| A6448 |
Light compression bandage, elastic, knitted/woven, width less than three inches, per yard |
12 |
12 |
$19.84 |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,929 |
2,700 |
$4.19 |
| A4245 |
Alcohol wipes, per box |
365 |
273 |
$0.00 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
668 |
594 |
$0.00 |
| A4211 |
Supplies for self-administered injections |
558 |
428 |
$0.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
178 |
166 |
$0.00 |
| B4081 |
Nasogastric tubing with stylet |
38 |
26 |
$0.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
174 |
124 |
$0.00 |
| V5266 |
Battery for use in hearing device |
193 |
154 |
$0.00 |
| A4550 |
Surgical trays |
14 |
12 |
$0.00 |
| A4461 |
Surgical dressing holder, non-reusable, each |
284 |
211 |
$0.00 |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
221 |
184 |
$0.00 |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
167 |
109 |
$0.00 |
| A7016 |
Dome and mouthpiece, used with small volume ultrasonic nebulizer |
78 |
68 |
$0.00 |
| A6224 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
185 |
116 |
$0.00 |
| A4252 |
Blood ketone test or reagent strip, each |
103 |
80 |
$0.00 |
| E1399 |
Durable medical equipment, miscellaneous |
90 |
63 |
$0.00 |
| A4657 |
Syringe, with or without needle, each |
78 |
52 |
$0.00 |
| A4301 |
Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) |
65 |
50 |
$0.00 |