| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
11,069 |
10,445 |
$1.39M |
| A4554 |
Disposable underpads, all sizes |
37,906 |
37,513 |
$1.38M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
11,368 |
10,849 |
$1.30M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
9,150 |
8,561 |
$1.30M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
10,436 |
10,137 |
$969K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,153 |
2,122 |
$426K |
| A4335 |
Incontinence supply; miscellaneous |
43,191 |
42,880 |
$232K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
2,664 |
2,649 |
$212K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
38,927 |
38,666 |
$184K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,173 |
2,081 |
$167K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,468 |
2,443 |
$129K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
962 |
940 |
$97K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
487 |
473 |
$58K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
2,612 |
1,585 |
$55K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
567 |
546 |
$48K |
| 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 |
343 |
279 |
$45K |
| E0277 |
Powered pressure-reducing air mattress |
313 |
278 |
$38K |
| E1399 |
Durable medical equipment, miscellaneous |
691 |
386 |
$37K |
| K0003 |
Lightweight wheelchair |
3,969 |
3,927 |
$36K |
| A4670 |
Automatic blood pressure monitor |
641 |
630 |
$31K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
397 |
379 |
$30K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
222 |
217 |
$28K |
| A4927 |
Gloves, non-sterile, per 100 |
2,948 |
2,929 |
$22K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,928 |
1,766 |
$21K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,428 |
1,267 |
$21K |
| E0570 |
Nebulizer, with compressor |
2,758 |
2,679 |
$19K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
603 |
289 |
$17K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,098 |
1,088 |
$16K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
649 |
646 |
$16K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
120 |
117 |
$15K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
3,799 |
3,721 |
$15K |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
326 |
318 |
$14K |
| 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 |
76 |
63 |
$11K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
742 |
474 |
$11K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
134 |
130 |
$8K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
112 |
106 |
$6K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
277 |
271 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,336 |
2,322 |
$6K |
| K0001 |
Standard wheelchair |
975 |
920 |
$6K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
131 |
92 |
$5K |
| A4259 |
Lancets, per box of 100 |
1,677 |
1,654 |
$4K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
129 |
129 |
$4K |
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
92 |
91 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
93 |
89 |
$3K |
| E0940 |
Trapeze bar, free standing, complete with grab bar |
97 |
93 |
$3K |
| K0006 |
Heavy duty wheelchair |
223 |
223 |
$3K |
| E0184 |
Dry pressure mattress |
118 |
115 |
$3K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
264 |
247 |
$3K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
144 |
91 |
$3K |
| A4245 |
Alcohol wipes, per box |
1,450 |
1,422 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
459 |
296 |
$2K |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
371 |
358 |
$2K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
16 |
12 |
$1K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
85 |
81 |
$1K |
| E2375 |
Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only |
107 |
107 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
409 |
395 |
$918.67 |
| A4256 |
Normal, low and high calibrator solution / chips |
902 |
892 |
$836.59 |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
13 |
13 |
$371.16 |
| A4258 |
Spring-powered device for lancet, each |
479 |
476 |
$334.16 |
| E1392 |
Portable oxygen concentrator, rental |
142 |
142 |
$326.14 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
13 |
12 |
$294.99 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
64 |
63 |
$229.02 |
| A7015 |
Aerosol mask, used with dme nebulizer |
223 |
213 |
$189.10 |
| E0607 |
Home blood glucose monitor |
33 |
33 |
$107.55 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
84 |
81 |
$44.04 |
| E0156 |
Seat attachment, walker |
121 |
121 |
$43.56 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
12 |
12 |
$32.13 |