| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
9,967 |
9,925 |
$938K |
| A4554 |
Disposable underpads, all sizes |
12,598 |
12,532 |
$910K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
6,487 |
6,471 |
$801K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,103 |
3,087 |
$395K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
2,602 |
2,545 |
$377K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,285 |
1,284 |
$222K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,747 |
2,738 |
$218K |
| E0570 |
Nebulizer, with compressor |
4,220 |
4,157 |
$213K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
6,036 |
5,623 |
$200K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
5,461 |
5,438 |
$182K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,830 |
4,802 |
$165K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,880 |
2,379 |
$155K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
760 |
596 |
$155K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,035 |
1,028 |
$151K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
432 |
429 |
$146K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,093 |
2,087 |
$123K |
| K0003 |
Lightweight wheelchair |
1,642 |
1,612 |
$109K |
| E1399 |
Durable medical equipment, miscellaneous |
165 |
153 |
$106K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,813 |
1,784 |
$101K |
| 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 |
2,545 |
2,542 |
$98K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
693 |
690 |
$72K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
768 |
718 |
$72K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,880 |
1,869 |
$67K |
| A4670 |
Automatic blood pressure monitor |
1,361 |
1,360 |
$65K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
2,397 |
2,365 |
$58K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,528 |
1,522 |
$53K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,321 |
1,005 |
$43K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,493 |
2,355 |
$34K |
| E0156 |
Seat attachment, walker |
2,251 |
2,242 |
$32K |
| S5165 |
Home modifications; per service |
27 |
26 |
$27K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
114 |
114 |
$21K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
498 |
495 |
$18K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
76 |
68 |
$17K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,348 |
1,344 |
$17K |
| K0001 |
Standard wheelchair |
439 |
433 |
$16K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
144 |
144 |
$14K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
13 |
13 |
$11K |
| K0040 |
Adjustable angle footplate, each |
166 |
120 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
2,212 |
2,201 |
$8K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
185 |
129 |
$7K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
113 |
110 |
$7K |
| K0004 |
High strength, lightweight wheelchair |
125 |
125 |
$6K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
116 |
114 |
$4K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
30 |
27 |
$3K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
143 |
96 |
$3K |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
125 |
125 |
$2K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
168 |
165 |
$2K |
| L0626 |
Lumbar orthosis, sagittal control, with rigid posterior panel(s), 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 padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
42 |
42 |
$2K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
13 |
12 |
$1K |
| E0271 |
Mattress, innerspring |
12 |
12 |
$1K |
| E0241 |
Bath tub wall rail, each |
24 |
24 |
$1K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
12 |
12 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
24 |
24 |
$641.70 |
| E0243 |
Toilet rail, each |
12 |
12 |
$584.69 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
59 |
37 |
$466.00 |
| K0019 |
Arm pad, replacement only, each |
12 |
12 |
$189.91 |