| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
4,103 |
2,642 |
$396K |
| A4670 |
Automatic blood pressure monitor |
3,266 |
3,265 |
$275K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,106 |
2,077 |
$197K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,623 |
2,607 |
$196K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,513 |
2,484 |
$194K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
1,103 |
1,103 |
$170K |
| E0570 |
Nebulizer, with compressor |
1,467 |
1,463 |
$126K |
| K0001 |
Standard wheelchair |
2,320 |
2,308 |
$125K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,336 |
1,319 |
$106K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,155 |
1,136 |
$100K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,643 |
1,155 |
$46K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,050 |
1,046 |
$45K |
| 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 |
1,593 |
908 |
$35K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
5,798 |
5,682 |
$33K |
| T5999 |
Supply, not otherwise specified |
1,285 |
1,267 |
$32K |
| E1399 |
Durable medical equipment, miscellaneous |
457 |
394 |
$30K |
| 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 |
1,332 |
758 |
$22K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
155 |
155 |
$22K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
700 |
698 |
$16K |
| E0245 |
Tub stool or bench |
159 |
159 |
$10K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
289 |
289 |
$9K |
| E0156 |
Seat attachment, walker |
673 |
671 |
$6K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
12 |
12 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
114 |
114 |
$2K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
92 |
92 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
725 |
723 |
$1K |
| A4259 |
Lancets, per box of 100 |
2,128 |
2,110 |
$1K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
12 |
12 |
$1K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
13 |
13 |
$467.47 |
| A4927 |
Gloves, non-sterile, per 100 |
14 |
13 |
$280.79 |
| E0607 |
Home blood glucose monitor |
12 |
12 |
$127.63 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
13 |
13 |
$0.00 |