| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
27,317 |
26,467 |
$1.36M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
16,886 |
16,378 |
$910K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
11,380 |
10,983 |
$908K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
9,762 |
9,485 |
$554K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,424 |
6,232 |
$533K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
6,911 |
6,638 |
$129K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
856 |
831 |
$121K |
| A4927 |
Gloves, non-sterile, per 100 |
22,112 |
21,465 |
$69K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,681 |
2,667 |
$63K |
| K0001 |
Standard wheelchair |
2,336 |
2,325 |
$44K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
823 |
796 |
$42K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,156 |
1,091 |
$41K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,241 |
1,177 |
$27K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,934 |
1,852 |
$26K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
698 |
698 |
$14K |
| V5266 |
Battery for use in hearing device |
584 |
582 |
$13K |
| A4402 |
Lubricant, per ounce |
1,965 |
1,896 |
$7K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
125 |
123 |
$6K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
273 |
273 |
$6K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
129 |
118 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
975 |
970 |
$3K |
| E0156 |
Seat attachment, walker |
271 |
271 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
12 |
12 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
134 |
113 |
$512.44 |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
16 |
16 |
$427.48 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
109 |
104 |
$328.51 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$278.89 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
14 |
14 |
$179.32 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
13 |
12 |
$65.86 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
12 |
12 |
$57.75 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
12 |
12 |
$22.16 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
13 |
13 |
$17.87 |
| A4259 |
Lancets, per box of 100 |
13 |
12 |
$3.40 |