| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
32,239 |
31,852 |
$1.93M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
19,757 |
19,519 |
$1.93M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
34,248 |
33,823 |
$1.60M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
7,380 |
7,285 |
$964K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,147 |
4,087 |
$376K |
| A4927 |
Gloves, non-sterile, per 100 |
30,939 |
30,547 |
$373K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,396 |
1,391 |
$92K |
| E0570 |
Nebulizer, with compressor |
754 |
730 |
$46K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
338 |
336 |
$36K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
112 |
112 |
$25K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
310 |
307 |
$21K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
180 |
180 |
$16K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
642 |
637 |
$10K |
| 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 |
405 |
310 |
$10K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
112 |
110 |
$10K |
| 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 |
405 |
309 |
$9K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,397 |
1,393 |
$6K |
| K0004 |
High strength, lightweight wheelchair |
300 |
292 |
$4K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
42 |
41 |
$4K |
| A4670 |
Automatic blood pressure monitor |
26 |
26 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
15 |
15 |
$2K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
16 |
16 |
$544.00 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
215 |
215 |
$412.42 |
| A4259 |
Lancets, per box of 100 |
1,107 |
1,103 |
$377.43 |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
13 |
13 |
$279.35 |