| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,751 |
4,397 |
$1.09M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,075 |
4,714 |
$1.06M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,799 |
2,602 |
$676K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,802 |
2,583 |
$518K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,965 |
4,544 |
$502K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,710 |
1,526 |
$463K |
| S9999 |
Sales tax |
30,164 |
26,494 |
$377K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
1,760 |
1,620 |
$347K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,738 |
1,644 |
$333K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,767 |
5,420 |
$299K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,436 |
1,330 |
$217K |
| A4927 |
Gloves, non-sterile, per 100 |
4,928 |
4,467 |
$179K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,724 |
4,436 |
$162K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,686 |
3,342 |
$118K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,174 |
652 |
$109K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
870 |
805 |
$102K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
513 |
491 |
$88K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,078 |
2,774 |
$81K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,047 |
767 |
$60K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,456 |
1,220 |
$48K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,731 |
1,611 |
$44K |
| A7030 |
Full face mask used with positive airway pressure device, each |
798 |
743 |
$39K |
| K0001 |
Standard wheelchair |
3,036 |
2,737 |
$36K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
240 |
227 |
$34K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
3,232 |
1,676 |
$34K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
209 |
195 |
$32K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,611 |
1,468 |
$31K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
54 |
50 |
$30K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,018 |
933 |
$28K |
| E0570 |
Nebulizer, with compressor |
3,058 |
2,932 |
$28K |
| K0003 |
Lightweight wheelchair |
1,713 |
1,539 |
$27K |
| A7031 |
Face mask interface, replacement for full face mask, each |
932 |
860 |
$24K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
599 |
540 |
$22K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
124 |
109 |
$20K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
260 |
240 |
$18K |
| E1399 |
Durable medical equipment, miscellaneous |
25 |
13 |
$15K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
324 |
290 |
$13K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
46 |
37 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
841 |
796 |
$13K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
65 |
53 |
$12K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
82 |
71 |
$9K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
113 |
102 |
$8K |
| A7035 |
Headgear used with positive airway pressure device |
918 |
831 |
$8K |
| K0007 |
Extra heavy duty wheelchair |
191 |
168 |
$8K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
196 |
186 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,060 |
1,887 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,991 |
1,035 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,156 |
1,076 |
$6K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
210 |
188 |
$6K |
| E0156 |
Seat attachment, walker |
636 |
590 |
$4K |
| E1392 |
Portable oxygen concentrator, rental |
267 |
231 |
$4K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
47 |
39 |
$3K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
215 |
210 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
520 |
477 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
520 |
473 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
207 |
176 |
$2K |
| K0040 |
Adjustable angle footplate, each |
33 |
25 |
$2K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
14 |
12 |
$2K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
293 |
261 |
$1K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
14 |
12 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
80 |
56 |
$1K |
| E0245 |
Tub stool or bench |
27 |
24 |
$1K |
| K0822 |
Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
12 |
12 |
$850.82 |
| A5120 |
Skin barrier, wipes or swabs, each |
163 |
153 |
$616.46 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
19 |
13 |
$336.84 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
14 |
13 |
$332.74 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
12 |
12 |
$312.06 |
| A4456 |
Adhesive remover, wipes, any type, each |
13 |
13 |
$233.12 |
| A7037 |
Tubing used with positive airway pressure device |
12 |
12 |
$185.69 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
14 |
13 |
$106.92 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
15 |
13 |
$35.02 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
13 |
13 |
$31.85 |