| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,700 |
3,511 |
$409K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
9,516 |
9,127 |
$385K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,523 |
3,386 |
$353K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,863 |
6,588 |
$345K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,419 |
3,236 |
$338K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,401 |
2,328 |
$322K |
| T4541 |
Incontinence product, disposable underpad, large, each |
12,730 |
12,216 |
$275K |
| A4927 |
Gloves, non-sterile, per 100 |
12,627 |
11,557 |
$237K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,462 |
1,408 |
$231K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
860 |
805 |
$229K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,701 |
1,662 |
$229K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,116 |
1,049 |
$192K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,386 |
1,348 |
$177K |
| E1399 |
Durable medical equipment, miscellaneous |
55 |
49 |
$139K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
991 |
714 |
$132K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,780 |
1,425 |
$89K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
649 |
639 |
$88K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,483 |
2,399 |
$75K |
| W0137 |
|
187 |
185 |
$40K |
| 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 |
596 |
499 |
$33K |
| K0001 |
Standard wheelchair |
1,624 |
1,580 |
$28K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
484 |
477 |
$25K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,474 |
1,363 |
$22K |
| A4335 |
Incontinence supply; miscellaneous |
1,515 |
1,229 |
$21K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
468 |
431 |
$15K |
| E0570 |
Nebulizer, with compressor |
1,389 |
1,263 |
$15K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
103 |
100 |
$13K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
154 |
139 |
$12K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
660 |
618 |
$12K |
| E0601 |
Continuous positive airway pressure (cpap) device |
330 |
277 |
$11K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
223 |
193 |
$10K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
141 |
137 |
$9K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
139 |
137 |
$8K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
169 |
167 |
$8K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
294 |
229 |
$8K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
132 |
120 |
$7K |
| A4456 |
Adhesive remover, wipes, any type, each |
822 |
773 |
$6K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
55 |
49 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
692 |
663 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,052 |
997 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
441 |
418 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
232 |
196 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
177 |
169 |
$3K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
26 |
25 |
$3K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
52 |
51 |
$2K |
| E0627 |
Seat lift mechanism, electric, any type |
12 |
12 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
489 |
450 |
$1K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
28 |
28 |
$1K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
12 |
12 |
$1K |
| A4554 |
Disposable underpads, all sizes |
98 |
97 |
$986.70 |
| K0003 |
Lightweight wheelchair |
51 |
48 |
$959.89 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
59 |
50 |
$956.07 |
| A7030 |
Full face mask used with positive airway pressure device, each |
13 |
13 |
$866.94 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
148 |
133 |
$576.05 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
25 |
12 |
$387.09 |
| A7037 |
Tubing used with positive airway pressure device |
14 |
13 |
$200.70 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$157.38 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
13 |
12 |
$36.74 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
314 |
298 |
$0.00 |