| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,962 |
1,873 |
$233K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,532 |
3,448 |
$175K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
979 |
928 |
$100K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
707 |
669 |
$94K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,260 |
1,162 |
$84K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,745 |
1,517 |
$82K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
306 |
298 |
$78K |
| E0570 |
Nebulizer, with compressor |
859 |
844 |
$64K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,566 |
1,442 |
$58K |
| K0001 |
Standard wheelchair |
3,676 |
3,425 |
$51K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,141 |
1,115 |
$48K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,626 |
1,513 |
$44K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,413 |
1,295 |
$40K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
936 |
912 |
$40K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
234 |
213 |
$31K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
885 |
788 |
$27K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,240 |
1,177 |
$22K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
85 |
81 |
$20K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
502 |
347 |
$19K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,723 |
1,687 |
$17K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
177 |
174 |
$17K |
| A7031 |
Face mask interface, replacement for full face mask, each |
529 |
512 |
$17K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
91 |
90 |
$16K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
375 |
352 |
$16K |
| A7030 |
Full face mask used with positive airway pressure device, each |
180 |
172 |
$15K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
131 |
129 |
$15K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
144 |
105 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
558 |
541 |
$9K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
39 |
35 |
$8K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
36 |
28 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,698 |
1,640 |
$7K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
102 |
100 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
217 |
188 |
$5K |
| A4565 |
Slings |
563 |
535 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
532 |
468 |
$5K |
| K0003 |
Lightweight wheelchair |
162 |
147 |
$4K |
| B9002 |
Enteral nutrition infusion pump, any type |
29 |
26 |
$4K |
| E0184 |
Dry pressure mattress |
540 |
465 |
$4K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
63 |
60 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
578 |
462 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
149 |
131 |
$3K |
| A4452 |
Tape, waterproof, per 18 square inches |
291 |
242 |
$3K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
122 |
95 |
$2K |
| E0305 |
Bed side rails, half length |
389 |
326 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
148 |
147 |
$1K |
| L3260 |
Surgical boot/shoe, each |
132 |
128 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
620 |
599 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
112 |
108 |
$1K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
28 |
25 |
$1K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
15 |
15 |
$1K |
| E0245 |
Tub stool or bench |
17 |
13 |
$937.37 |
| E0156 |
Seat attachment, walker |
26 |
26 |
$316.37 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
314 |
247 |
$0.00 |