| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
9,677 |
8,535 |
$1.08M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
18,451 |
16,780 |
$973K |
| E0601 |
Continuous positive airway pressure (cpap) device |
19,473 |
17,821 |
$926K |
| A7030 |
Full face mask used with positive airway pressure device, each |
8,969 |
8,219 |
$654K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,445 |
3,808 |
$590K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
17,838 |
16,249 |
$503K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,982 |
4,465 |
$468K |
| A7031 |
Face mask interface, replacement for full face mask, each |
13,933 |
12,801 |
$467K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,727 |
1,539 |
$386K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,724 |
4,057 |
$385K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
4,667 |
2,025 |
$379K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,139 |
5,960 |
$378K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
3,005 |
2,774 |
$304K |
| S9999 |
Sales tax |
31,268 |
27,246 |
$303K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,089 |
926 |
$290K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,402 |
5,306 |
$283K |
| A4927 |
Gloves, non-sterile, per 100 |
7,455 |
7,265 |
$269K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
5,887 |
5,378 |
$261K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
5,744 |
5,593 |
$253K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
6,200 |
5,591 |
$233K |
| E0570 |
Nebulizer, with compressor |
8,811 |
8,060 |
$205K |
| A7035 |
Headgear used with positive airway pressure device |
12,304 |
11,214 |
$178K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,577 |
1,351 |
$157K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
27,628 |
25,155 |
$130K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
486 |
449 |
$123K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
929 |
775 |
$117K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,703 |
7,927 |
$107K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,094 |
2,913 |
$102K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,199 |
1,023 |
$93K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
87 |
76 |
$81K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
324 |
308 |
$80K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,762 |
2,573 |
$59K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,162 |
1,994 |
$59K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
3,993 |
1,757 |
$54K |
| K0003 |
Lightweight wheelchair |
2,085 |
1,962 |
$53K |
| E1392 |
Portable oxygen concentrator, rental |
2,841 |
2,480 |
$50K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
592 |
217 |
$49K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,445 |
1,315 |
$49K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
5,059 |
4,716 |
$45K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
756 |
619 |
$45K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
297 |
269 |
$42K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
604 |
356 |
$41K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
525 |
443 |
$33K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,988 |
1,845 |
$33K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
4,693 |
4,344 |
$25K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
69 |
60 |
$21K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
1,326 |
1,228 |
$20K |
| K0001 |
Standard wheelchair |
714 |
669 |
$18K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
157 |
134 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
915 |
836 |
$11K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
272 |
224 |
$10K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
270 |
184 |
$9K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
90 |
65 |
$9K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
328 |
274 |
$9K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
37 |
37 |
$8K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,259 |
1,034 |
$8K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
42 |
41 |
$8K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
51 |
50 |
$7K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
373 |
314 |
$7K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
86 |
66 |
$7K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
900 |
737 |
$6K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
505 |
468 |
$6K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
370 |
151 |
$4K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
128 |
77 |
$4K |
| J9190 |
Injection, fluorouracil, 500 mg |
833 |
405 |
$4K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
72 |
52 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,118 |
1,049 |
$3K |
| E0156 |
Seat attachment, walker |
359 |
320 |
$3K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
26 |
25 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
457 |
409 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
15 |
15 |
$2K |
| A7036 |
Chinstrap used with positive airway pressure device |
199 |
191 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
14 |
12 |
$2K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
114 |
91 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
726 |
702 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
104 |
78 |
$900.86 |
| A4367 |
Ostomy belt, each |
88 |
73 |
$860.07 |
| A4456 |
Adhesive remover, wipes, any type, each |
52 |
42 |
$439.78 |
| A4306 |
Disposable drug delivery system, flow rate of less than 50 ml per hour |
168 |
80 |
$436.05 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
20 |
12 |
$355.37 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
191 |
167 |
$243.96 |
| A4371 |
Ostomy skin barrier, powder, per oz |
69 |
54 |
$216.72 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
30 |
24 |
$137.80 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
15 |
12 |
$96.32 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
12 |
$96.02 |
| A4930 |
Gloves, sterile, per pair |
35 |
26 |
$31.70 |
| A4245 |
Alcohol wipes, per box |
22 |
15 |
$4.98 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
13 |
13 |
$3.86 |
| A9270 |
Non-covered item or service |
12 |
12 |
$0.00 |