| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
16,903 |
16,483 |
$1.95M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
17,623 |
17,478 |
$1.53M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
15,082 |
14,936 |
$1.37M |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
13,037 |
12,572 |
$995K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
8,910 |
8,843 |
$964K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,344 |
8,245 |
$862K |
| T4541 |
Incontinence product, disposable underpad, large, each |
25,011 |
24,852 |
$848K |
| A4927 |
Gloves, non-sterile, per 100 |
26,180 |
25,908 |
$642K |
| 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 |
4,345 |
4,179 |
$517K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
11,823 |
11,661 |
$513K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,916 |
3,880 |
$464K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,711 |
4,636 |
$380K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
3,200 |
3,138 |
$374K |
| E0570 |
Nebulizer, with compressor |
4,689 |
4,647 |
$361K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,697 |
2,506 |
$343K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,122 |
3,086 |
$328K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,112 |
2,094 |
$320K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
568 |
552 |
$277K |
| A4670 |
Automatic blood pressure monitor |
4,325 |
4,301 |
$242K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,393 |
1,384 |
$174K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
754 |
736 |
$161K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
8,922 |
8,889 |
$145K |
| E0245 |
Tub stool or bench |
3,423 |
3,406 |
$137K |
| K0001 |
Standard wheelchair |
4,014 |
3,933 |
$131K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,151 |
1,049 |
$107K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,879 |
1,661 |
$102K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,708 |
1,684 |
$91K |
| B4100 |
Food thickener, administered orally, per ounce |
1,825 |
1,788 |
$79K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,197 |
1,103 |
$69K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,985 |
1,927 |
$68K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
314 |
307 |
$63K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,554 |
2,533 |
$50K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
15,536 |
15,356 |
$43K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
147 |
147 |
$23K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
264 |
252 |
$23K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
487 |
479 |
$21K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,116 |
2,973 |
$20K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,734 |
1,720 |
$18K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,196 |
2,064 |
$14K |
| E0244 |
Raised toilet seat |
280 |
279 |
$13K |
| K0003 |
Lightweight wheelchair |
163 |
161 |
$12K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
760 |
693 |
$9K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
373 |
371 |
$8K |
| E0156 |
Seat attachment, walker |
884 |
873 |
$7K |
| E0241 |
Bath tub wall rail, each |
233 |
220 |
$7K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
89 |
89 |
$7K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
715 |
707 |
$7K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
52 |
52 |
$6K |
| A4402 |
Lubricant, per ounce |
1,020 |
947 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,779 |
2,765 |
$4K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
2,123 |
2,074 |
$4K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
45 |
44 |
$3K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
16 |
12 |
$2K |
| V2020 |
Frames, purchases |
20 |
20 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
96 |
94 |
$2K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
104 |
88 |
$2K |
| 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 |
51 |
50 |
$1K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
27 |
27 |
$1K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
25 |
25 |
$904.37 |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
12 |
12 |
$765.80 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
40 |
37 |
$759.49 |
| A4322 |
Irrigation syringe, bulb or piston, each |
184 |
182 |
$752.29 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
180 |
179 |
$738.16 |
| A5120 |
Skin barrier, wipes or swabs, each |
91 |
90 |
$721.22 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$703.80 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
397 |
396 |
$635.56 |
| A4245 |
Alcohol wipes, per box |
94 |
88 |
$454.18 |
| A4335 |
Incontinence supply; miscellaneous |
77 |
62 |
$429.20 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
14 |
14 |
$413.23 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$359.80 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
39 |
36 |
$329.70 |
| 92015 |
Determination of refractive state |
14 |
14 |
$197.40 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
12 |
12 |
$65.39 |
| 90662 |
|
29 |
29 |
$0.00 |
| 90756 |
|
85 |
85 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
359 |
359 |
$0.00 |
| 90688 |
|
21 |
21 |
$0.00 |
| 90674 |
|
106 |
106 |
$0.00 |
| 90686 |
|
71 |
71 |
$0.00 |