| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0240 |
Bath/shower chair |
1,793 |
1,776 |
$991K |
| K0823 |
Pwc gp 2 std cap chair |
3,276 |
2,501 |
$652K |
| E1399 |
Durable medical equipment mi |
3,396 |
3,208 |
$643K |
| K0800 |
Pov group 1 std up to 300lbs |
1,093 |
1,056 |
$380K |
| K0108 |
W/c component-accessory nos |
5,076 |
3,753 |
$327K |
| K0739 |
Repair/svc dme non-oxygen eq |
5,846 |
5,509 |
$128K |
| E2386 |
Foam filled drive wheel tire |
1,246 |
1,108 |
$98K |
| T4530 |
Ped size brief/diaper lg |
26,178 |
25,714 |
$76K |
| E2365 |
U1 sealed leadacid battery |
1,744 |
1,537 |
$74K |
| A4352 |
Coude tip urinary catheter |
839 |
812 |
$50K |
| E0973 |
W/ch access det adj armrest |
1,786 |
1,417 |
$49K |
| E2361 |
22nf sealed leadacid battery |
672 |
572 |
$40K |
| E2366 |
Battery charger, single mode |
867 |
777 |
$40K |
| E2370 |
Pwr wc dr wh motor/gear comb |
134 |
114 |
$38K |
| E1028 |
W/c manual swingaway |
853 |
694 |
$37K |
| T4534 |
Youth size pull-on |
37,449 |
37,157 |
$33K |
| E2392 |
Solid caster tire, integrate |
859 |
778 |
$33K |
| E1390 |
Oxygen concentrator |
102,633 |
98,619 |
$29K |
| E0445 |
Oximeter non-invasive |
10,496 |
10,317 |
$27K |
| T4533 |
Youth size brief/diaper |
6,338 |
6,258 |
$25K |
| T4522 |
Adult size brief/diaper med |
19,606 |
19,422 |
$24K |
| A4351 |
Straight tip urine catheter |
6,446 |
6,059 |
$22K |
| E1161 |
Manual adult wc w tiltinspac |
219 |
217 |
$22K |
| K0462 |
Temporary replacement eqpmnt |
128 |
122 |
$14K |
| K0040 |
Adjustable angle footplate |
449 |
421 |
$12K |
| E2622 |
Adj skin pro w/c cus wd<22in |
115 |
107 |
$11K |
| E0955 |
Cushioned headrest |
428 |
391 |
$10K |
| K0733 |
12-24hr sealed lead acid |
419 |
400 |
$9K |
| A4385 |
Ost skn barrier sld ext wear |
3,038 |
2,899 |
$7K |
| E0971 |
Wheelchair anti-tipping devi |
3,920 |
3,827 |
$6K |
| A4353 |
Intermittent urinary cath |
201 |
183 |
$5K |
| E2624 |
Adj skin pro/pos cus<22in |
90 |
82 |
$5K |
| E0978 |
W/c acc,saf belt pelv strap |
3,196 |
3,047 |
$5K |
| E0431 |
Portable gaseous 02 |
82,960 |
79,699 |
$5K |
| E2607 |
Skin pro/pos wc cus wd <22in |
97 |
88 |
$5K |
| K0019 |
Arm pad repl, each |
585 |
539 |
$4K |
| E2374 |
Hand/chin ctrl std joystick |
39 |
36 |
$4K |
| E0570 |
Nebulizer with compression |
14,866 |
14,734 |
$4K |
| T4532 |
Ped size pull-on lg |
8,771 |
8,678 |
$4K |
| T4523 |
Adult size brief/diaper lg |
10,906 |
10,744 |
$4K |
| E0651 |
Pneum compressor segmental |
597 |
586 |
$4K |
| A6212 |
Foam drg <=16 sq in w/border |
646 |
608 |
$4K |
| T4521 |
Adult size brief/diaper sm |
4,054 |
4,019 |
$4K |
| E2394 |
Drive wheel excludes tire |
82 |
77 |
$3K |
| K0825 |
Pwc gp 2 hd cap chair |
37 |
24 |
$3K |
| A4407 |
Ext wear ost skn barr <=4sq" |
781 |
757 |
$3K |
| A7030 |
Cpap full face mask |
15,890 |
15,654 |
$3K |
| E0247 |
Trans bench w/wo comm open |
506 |
501 |
$2K |
| T4526 |
Adult size pull-on med |
11,786 |
11,711 |
$2K |
| A4927 |
Non-sterile gloves |
1,029 |
906 |
$2K |
| A4425 |
Ost pch drain for barrier fl |
3,229 |
3,089 |
$2K |
| A6197 |
Alginate drsg >16 <=48 sq in |
860 |
828 |
$2K |
| A4520 |
Incontinence garment anytype |
1,420 |
1,397 |
$2K |
| E0601 |
Cont airway pressure device |
77,203 |
75,107 |
$2K |
| K0001 |
Standard wheelchair |
28,152 |
27,379 |
$2K |
| E2620 |
Wc planar back cush wd <22in |
13 |
12 |
$2K |
| A4362 |
Solid skin barrier |
267 |
251 |
$2K |
| E0471 |
Rad w/backup non inv intrfc |
4,720 |
4,563 |
$1K |
| A4357 |
Bedside drainage bag |
2,296 |
2,034 |
$1K |
| T4531 |
Ped size pull-on sm/med |
2,410 |
2,379 |
$1K |
| K0003 |
Lightweight wheelchair |
5,478 |
5,360 |
$1K |
| E0960 |
W/c shoulder harness/straps |
122 |
116 |
$1K |
| E0562 |
Humidifier heated used w pap |
6,537 |
6,451 |
$1K |
| E1226 |
Manual fully reclining back |
2,107 |
2,071 |
$1K |
| K0195 |
Elevating whlchair leg rests |
13,621 |
13,231 |
$1K |
| A5063 |
Drain ostomy pouch w/flange |
780 |
746 |
$1K |
| A7031 |
Replacement facemask interfa |
11,602 |
11,444 |
$937.43 |
| A4216 |
Sterile water/saline, 10 ml |
7,244 |
6,836 |
$913.23 |
| E0143 |
Walker folding wheeled w/o s |
5,853 |
5,799 |
$891.48 |
| A4409 |
Ost skn barr convex <=4 sq i |
3,094 |
2,973 |
$837.51 |
| A4349 |
Disposable male external cat |
250 |
219 |
$805.94 |
| A4452 |
Waterproof tape |
1,728 |
1,678 |
$618.90 |
| A7005 |
Nondisposable nebulizer set |
15,550 |
15,400 |
$544.14 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,038 |
1,007 |
$527.44 |
| E0630 |
Patient lift hydraulic |
3,075 |
2,980 |
$517.50 |
| A7037 |
Pos airway pressure tubing |
21,661 |
21,322 |
$504.31 |
| A5120 |
Skin barrier, wipe or swab |
4,200 |
4,040 |
$477.39 |
| A7035 |
Pos airway press headgear |
17,993 |
17,720 |
$388.07 |
| A4338 |
Indwelling catheter latex |
986 |
874 |
$351.97 |
| A4310 |
Insert tray w/o bag/cath |
1,129 |
1,059 |
$344.90 |
| A7034 |
Nasal application device |
10,529 |
10,432 |
$322.55 |
| A6216 |
Non-sterile gauze<=16 sq in |
3,088 |
2,986 |
$320.75 |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
242 |
233 |
$312.96 |
| E0603 |
Electric breast pump |
2,931 |
2,913 |
$298.99 |
| A6253 |
Absorpt drg > 48 sq in w/o b |
97 |
94 |
$294.00 |
| E0470 |
Rad w/o backup non-inv intfc |
12,803 |
12,429 |
$282.17 |
| A7038 |
Pos airway pressure filter |
44,454 |
43,246 |
$279.70 |
| E2601 |
Gen w/c cushion wdth < 22 in |
137 |
133 |
$278.76 |
| A7033 |
Replacement nasal pillows |
5,913 |
5,756 |
$272.93 |
| E0956 |
W/c lateral trunk/hip suppor |
27 |
24 |
$239.13 |
| A4358 |
Urinary leg or abdomen bag |
981 |
856 |
$237.16 |
| A6446 |
Conform band s w>=3" <5"/yd |
1,633 |
1,599 |
$234.52 |
| A4320 |
Irrigation tray |
735 |
650 |
$231.03 |
| A4624 |
Tracheal suction tube |
4,044 |
3,906 |
$228.86 |
| E0265 |
Hosp bed total electr w/ mat |
275 |
253 |
$202.63 |
| E0245 |
Tub stool or bench |
697 |
693 |
$172.18 |
| E2208 |
Cylinder tank carrier |
17 |
13 |
$160.95 |
| A4371 |
Skin barrier powder per oz |
1,793 |
1,710 |
$149.42 |
| K0007 |
Extra heavy duty wheelchair |
2,222 |
2,118 |
$143.16 |
| E2211 |
Pneumatic propulsion tire |
13 |
12 |
$135.17 |
| A4367 |
Ostomy belt |
914 |
875 |
$132.69 |
| A7032 |
Replacement nasal cushion |
8,892 |
8,613 |
$128.62 |
| E0635 |
Patient lift electric |
446 |
435 |
$128.02 |
| A4629 |
Tracheostomy care kit |
2,244 |
2,201 |
$123.78 |
| E0951 |
Loop heel |
34 |
25 |
$112.81 |
| T4527 |
Adult size pull-on lg |
5,417 |
5,355 |
$100.80 |
| A4322 |
Irrigation syringe |
884 |
847 |
$99.24 |
| E1392 |
Portable oxygen concentrator |
3,065 |
2,904 |
$99.03 |
| K0004 |
High strength ltwt whlchr |
14 |
13 |
$96.07 |
| E0621 |
Patient lift sling or seat |
104 |
101 |
$91.97 |
| A7039 |
Filter, non disposable w pap |
13,174 |
12,995 |
$90.04 |
| A4402 |
Lubricant per ounce |
2,627 |
2,491 |
$89.72 |
| A5061 |
Pouch drainable w barrier at |
25 |
24 |
$82.53 |
| A6402 |
Sterile gauze <= 16 sq in |
4,452 |
4,286 |
$77.14 |
| A4615 |
Cannula nasal |
3,441 |
3,069 |
$75.58 |
| A7520 |
Trach/laryn tube non-cuffed |
4,114 |
3,976 |
$74.26 |
| E0156 |
Walker seat attachment |
1,557 |
1,537 |
$69.69 |
| A7526 |
Tracheostomy tube collar |
4,725 |
4,577 |
$65.70 |
| A7015 |
Aerosol mask used w nebulize |
7,921 |
7,859 |
$56.25 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
98 |
97 |
$54.92 |
| E0600 |
Suction pump portab hom modl |
8,488 |
8,267 |
$48.57 |
| A7046 |
Repl water chamber, pap dev |
6,470 |
6,337 |
$47.72 |
| A4406 |
Pectin based ostomy paste |
1,488 |
1,414 |
$47.24 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
341 |
331 |
$45.36 |
| A4670 |
Automatic bp monitor, dial |
2,203 |
2,191 |
$38.50 |
| A7521 |
Trach/laryn tube cuffed |
647 |
601 |
$32.57 |
| A6254 |
Absorpt drg <=16 sq in w/bdr |
353 |
341 |
$32.16 |
| A4455 |
Adhesive remover per ounce |
243 |
238 |
$25.01 |
| A6266 |
Impreg gauze no h20/sal/yard |
126 |
125 |
$18.80 |
| A4450 |
Non-waterproof tape |
1,493 |
1,439 |
$15.03 |
| A6449 |
Lt compres band >=3" <5"/yd |
337 |
333 |
$13.43 |
| A6457 |
Tubular dressing |
398 |
377 |
$11.59 |
| A4649 |
Surgical supplies |
8,602 |
6,826 |
$10.29 |
| A4604 |
Tubing with heating element |
4,701 |
4,652 |
$9.59 |
| A4394 |
Ostomy pouch liq deodorant |
489 |
479 |
$7.21 |
| A7012 |
Nebulizer water collec devic |
2,082 |
2,011 |
$7.06 |
| A4606 |
Oxygen probe used w oximeter |
2,300 |
2,226 |
$7.05 |
| A4628 |
Oropharyngeal suction cath |
3,929 |
3,708 |
$6.09 |
| A7003 |
Nebulizer administration set |
3,333 |
3,284 |
$3.39 |
| A7002 |
Tubing used w suction pump |
6,584 |
5,987 |
$2.98 |
| A4217 |
Sterile water/saline, 500 ml |
1,583 |
1,521 |
$2.10 |
| A4332 |
Lube sterile packet |
514 |
463 |
$1.06 |
| E0465 |
Home vent invasive interface |
2,644 |
2,562 |
$0.00 |
| A4213 |
20+ cc syringe only |
189 |
176 |
$0.00 |
| E1038 |
Transport chair pt wt<=300lb |
204 |
202 |
$0.00 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
9,631 |
7,822 |
$0.00 |
| B4103 |
Ef ped fluid and electrolyte |
586 |
562 |
$0.00 |
| A4557 |
Lead wires, pair |
764 |
761 |
$0.00 |
| B4153 |
Ef hydrolyzed/amino acids |
929 |
848 |
$0.00 |
| E0730 |
Tens four lead |
999 |
978 |
$0.00 |
| E0434 |
Portable liquid 02 |
974 |
941 |
$0.00 |
| B4150 |
Ef complet w/intact nutrient |
1,494 |
1,357 |
$0.00 |
| E0202 |
Phototherapy light w/ photom |
13 |
13 |
$0.00 |
| A7507 |
Integrated filter & holder |
1,318 |
1,286 |
$0.00 |
| E0277 |
Powered pres-redu air mattrs |
596 |
588 |
$0.00 |
| A9900 |
Supply/accessory/service |
653 |
617 |
$0.00 |
| E0100 |
Cane adjust/fixed with tip |
319 |
315 |
$0.00 |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,649 |
3,155 |
$0.00 |
| E0424 |
Stationary compressed gas 02 |
404 |
357 |
$0.00 |
| E0181 |
Press pad alternating w/ pum |
1,315 |
1,272 |
$0.00 |
| T4543 |
Adult disp brief/diap abv xl |
602 |
598 |
$0.00 |
| E0439 |
Stationary liquid 02 |
1,097 |
1,065 |
$0.00 |
| B4161 |
Ef ped hydrolyzed/amino acid |
4,650 |
4,131 |
$0.00 |
| E0482 |
Cough stimulating device |
1,289 |
1,254 |
$0.00 |
| A7527 |
Trach/laryn tube plug/stop |
590 |
578 |
$0.00 |
| B4149 |
Ef blenderized foods |
1,912 |
1,539 |
$0.00 |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,005 |
953 |
$0.00 |
| E0619 |
Apnea monitor w recorder |
978 |
973 |
$0.00 |
| L8501 |
Tracheostomy speaking valve |
299 |
299 |
$0.00 |
| A4483 |
Moisture exchanger |
2,426 |
2,343 |
$0.00 |
| A4657 |
Syringe w/wo needle |
124 |
122 |
$0.00 |
| A7509 |
Heat & moisture exchange sys |
153 |
150 |
$0.00 |
| E0776 |
Iv pole |
833 |
828 |
$0.00 |
| A4419 |
Ost pch for bar w flange/flt |
186 |
167 |
$0.00 |
| B4100 |
Food thickener oral |
401 |
383 |
$0.00 |
| T4529 |
Ped size brief/diaper sm/med |
265 |
263 |
$0.00 |
| E0105 |
Cane adjust/fixed quad/3 pro |
14 |
14 |
$0.00 |
| B9998 |
Enteral supp not otherwise c |
234 |
226 |
$0.00 |
| K0053 |
Elevate footrest articulate |
12 |
12 |
$0.00 |
| E0303 |
Hosp bed hvy dty xtra wide |
12 |
12 |
$0.00 |
| A4364 |
Adhesive, liquid or equal |
12 |
12 |
$0.00 |
| E0114 |
Crutch underarm pair no wood |
966 |
955 |
$0.00 |
| A7000 |
Disposable canister for pump |
6,085 |
5,877 |
$0.00 |
| B4035 |
Enteral feed supp pump per d |
11,151 |
10,989 |
$0.00 |
| A4247 |
Betadine/iodine swabs/wipes |
562 |
540 |
$0.00 |
| E0244 |
Toilet seat raised |
42 |
42 |
$0.00 |
| A7525 |
Tracheostomy mask |
3,034 |
2,950 |
$0.00 |
| B4034 |
Enter feed supkit syr by day |
3,268 |
3,108 |
$0.00 |
| E0550 |
Humidif extens supple w ippb |
3,149 |
3,052 |
$0.00 |
| A7007 |
Lg vol nebulizer disposable |
1,597 |
1,568 |
$0.00 |
| A4618 |
Breathing circuits |
1,810 |
1,737 |
$0.00 |
| T4544 |
Adlt disp und/pull on abv xl |
629 |
606 |
$0.00 |
| A4432 |
Os pch urine w bar/fange/tap |
296 |
281 |
$0.00 |
| A4605 |
Trach suction cath close sys |
585 |
568 |
$0.00 |
| A4595 |
Tens suppl 2 lead per month |
1,535 |
1,512 |
$0.00 |
| E0565 |
Compressor air power source |
2,091 |
2,048 |
$0.00 |
| E1372 |
Oxy suppl heater for nebuliz |
486 |
464 |
$0.00 |
| A4623 |
Tracheostomy inner cannula |
844 |
788 |
$0.00 |
| E0466 |
Home vent non-invasive inter |
1,158 |
1,119 |
$0.00 |
| E0260 |
Hosp bed semi-electr w/ matt |
5,206 |
4,993 |
$0.00 |
| A7036 |
Pos airway press chinstrap |
195 |
193 |
$0.00 |
| B4036 |
Enteral feed sup kit grav by |
535 |
493 |
$0.00 |
| A7010 |
Disposable corrugated tubing |
250 |
245 |
$0.00 |
| T4524 |
Adult size brief/diaper xl |
3,797 |
3,779 |
$0.00 |
| B4158 |
Ef ped complete intact nut |
335 |
305 |
$0.00 |
| E0163 |
Commode chair with fixed arm |
288 |
286 |
$0.00 |
| B4104 |
Additive for enteral formula |
771 |
722 |
$0.00 |
| E0149 |
Heavy duty wheeled walker |
104 |
103 |
$0.00 |
| B9002 |
Enter nutr inf pump any type |
11,060 |
10,896 |
$0.00 |
| T4528 |
Adult size pull-on xl |
3,191 |
3,177 |
$0.00 |
| B4154 |
Ef spec metabolic noninherit |
474 |
414 |
$0.00 |
| T4525 |
Adult size pull-on sm |
195 |
192 |
$0.00 |
| A6248 |
Hydrogel drsg gel filler |
31 |
25 |
$0.00 |
| K0006 |
Heavy duty wheelchair |
84 |
83 |
$0.00 |
| A6210 |
Foam drg >16<=48 sq in w/o b |
12 |
12 |
$0.00 |
| B4155 |
Ef incomplete/modular |
1,740 |
1,594 |
$0.00 |
| A6219 |
Gauze <= 16 sq in w/border |
19 |
17 |
$0.00 |
| A6021 |
Collagen dressing <=16 sq in |
15 |
15 |
$0.00 |
| A6196 |
Alginate dressing <=16 sq in |
13 |
13 |
$0.00 |