| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
6,968 |
2,141 |
$3.42M |
| K0108 |
W/c component-accessory nos |
12,296 |
3,666 |
$1.55M |
| E2617 |
Custom fab w/c back cushion |
1,039 |
907 |
$1.48M |
| A4554 |
Disposable underpads |
45,289 |
44,439 |
$1.47M |
| T4527 |
Adult size pull-on lg |
10,918 |
10,150 |
$1.32M |
| E2609 |
Custom fabricate w/c cushion |
932 |
824 |
$1.18M |
| B4035 |
Enteral feed supp pump per d |
4,199 |
3,998 |
$1.08M |
| E0240 |
Bath/shower chair |
793 |
732 |
$1.04M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,101 |
3,629 |
$1.03M |
| T4526 |
Adult size pull-on med |
9,347 |
9,088 |
$994K |
| B4153 |
Ef hydrolyzed/amino acids |
623 |
579 |
$885K |
| B4161 |
Ef ped hydrolyzed/amino acid |
873 |
794 |
$779K |
| T4522 |
Adult size brief/diaper med |
7,966 |
7,486 |
$739K |
| E8001 |
Upright gait trainer |
314 |
299 |
$726K |
| T4528 |
Adult size pull-on xl |
4,631 |
4,366 |
$722K |
| B9998 |
Enteral supp not otherwise c |
8,741 |
6,484 |
$649K |
| E1028 |
W/c manual swingaway |
8,208 |
5,144 |
$600K |
| E1161 |
Manual adult wc w tiltinspac |
2,426 |
2,389 |
$557K |
| B4150 |
Ef complet w/intact nutrient |
2,033 |
1,865 |
$548K |
| T4523 |
Adult size brief/diaper lg |
5,355 |
4,943 |
$511K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,719 |
1,548 |
$509K |
| A9900 |
Supply/accessory/service |
1,860 |
301 |
$459K |
| E0329 |
Ped hospital bed semi/elect |
86 |
73 |
$406K |
| T4524 |
Adult size brief/diaper xl |
2,739 |
2,659 |
$353K |
| K0739 |
Repair/svc dme non-oxygen eq |
6,480 |
4,162 |
$331K |
| T4525 |
Adult size pull-on sm |
3,349 |
3,215 |
$293K |
| A4335 |
Incontinence supply |
52,377 |
51,472 |
$276K |
| B4034 |
Enter feed supkit syr by day |
2,356 |
2,270 |
$262K |
| A4351 |
Straight tip urine catheter |
1,816 |
1,629 |
$242K |
| E0955 |
Cushioned headrest |
4,090 |
3,899 |
$227K |
| K0005 |
Ultralightweight wheelchair |
213 |
195 |
$225K |
| T4534 |
Youth size pull-on |
2,183 |
2,104 |
$217K |
| T4535 |
Disposable liner/shield/pad |
8,659 |
8,358 |
$203K |
| B4155 |
Ef incomplete/modular |
486 |
458 |
$184K |
| T2029 |
Special med equip, noswaiver |
231 |
211 |
$155K |
| E0637 |
Combination sit to stand sys |
71 |
64 |
$149K |
| E2607 |
Skin pro/pos wc cus wd <22in |
600 |
549 |
$147K |
| E0973 |
W/ch access det adj armrest |
2,093 |
1,712 |
$145K |
| T4530 |
Ped size brief/diaper lg |
1,670 |
1,616 |
$145K |
| T4532 |
Ped size pull-on lg |
889 |
854 |
$126K |
| K0040 |
Adjustable angle footplate |
1,833 |
1,560 |
$125K |
| T4544 |
Adlt disp und/pull on abv xl |
530 |
526 |
$122K |
| E0956 |
W/c lateral trunk/hip suppor |
934 |
794 |
$120K |
| B4149 |
Ef blenderized foods |
240 |
214 |
$118K |
| E0630 |
Patient lift hydraulic |
628 |
600 |
$118K |
| E0950 |
Tray |
1,079 |
1,016 |
$115K |
| E0960 |
W/c shoulder harness/straps |
1,813 |
1,690 |
$110K |
| T4521 |
Adult size brief/diaper sm |
1,147 |
1,093 |
$102K |
| K0823 |
Pwc gp 2 std cap chair |
80 |
77 |
$71K |
| E0971 |
Wheelchair anti-tipping devi |
1,612 |
1,370 |
$69K |
| 97542 |
|
3,000 |
2,467 |
$66K |
| E2613 |
Position back cush wd <22in |
203 |
180 |
$64K |
| E0641 |
Multi-position stnd fram sys |
29 |
28 |
$61K |
| E0260 |
Hosp bed semi-electr w/ matt |
704 |
687 |
$50K |
| E0978 |
W/c acc,saf belt pelv strap |
2,194 |
2,024 |
$48K |
| A7000 |
Disposable canister for pump |
2,107 |
2,041 |
$44K |
| A4353 |
Intermittent urinary cath |
103 |
95 |
$43K |
| B4036 |
Enteral feed sup kit grav by |
233 |
227 |
$37K |
| A6250 |
Skin seal protect moisturizr |
6,955 |
6,811 |
$32K |
| A4322 |
Irrigation syringe |
3,682 |
3,561 |
$31K |
| A7002 |
Tubing used w suction pump |
2,399 |
2,082 |
$30K |
| A6402 |
Sterile gauze <= 16 sq in |
3,368 |
3,246 |
$26K |
| E1234 |
Fld ped wc tltnspc w/o seat |
13 |
12 |
$20K |
| E2361 |
22nf sealed leadacid battery |
117 |
92 |
$19K |
| E0953 |
W/c lateral thigh/knee sup |
141 |
120 |
$17K |
| E2213 |
Pneumatic prop tire insert |
627 |
489 |
$16K |
| T1999 |
Noc retail items andsupplies |
1,922 |
1,460 |
$15K |
| T4533 |
Youth size brief/diaper |
144 |
138 |
$13K |
| E0961 |
Wheelchair brake extension |
560 |
475 |
$13K |
| A4927 |
Non-sterile gloves |
1,688 |
1,632 |
$11K |
| A4628 |
Oropharyngeal suction cath |
2,124 |
1,988 |
$11K |
| T4543 |
Adult disp brief/diap abv xl |
63 |
63 |
$10K |
| A4357 |
Bedside drainage bag |
609 |
583 |
$10K |
| E0951 |
Loop heel |
685 |
544 |
$7K |
| A4402 |
Lubricant per ounce |
1,208 |
1,135 |
$5K |
| E2211 |
Pneumatic propulsion tire |
177 |
147 |
$4K |
| E2363 |
Gr24 sealed leadacid battery |
15 |
14 |
$3K |
| K0019 |
Arm pad repl, each |
248 |
189 |
$3K |
| A4450 |
Non-waterproof tape |
1,973 |
1,894 |
$3K |
| A4624 |
Tracheal suction tube |
54 |
53 |
$3K |
| A7003 |
Nebulizer administration set |
1,026 |
1,006 |
$3K |
| E2206 |
Man wc whl lock comp repl ea |
82 |
60 |
$3K |
| K0038 |
Leg strap each |
139 |
128 |
$2K |
| K0043 |
Ftrst lowr exten tube rep ea |
76 |
66 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
144 |
121 |
$1K |
| B4100 |
Food thickener oral |
24 |
24 |
$794.07 |
| A7015 |
Aerosol mask used w nebulize |
528 |
506 |
$507.23 |
| E0952 |
Toe loop/holder, each |
36 |
31 |
$449.49 |
| A4213 |
20+ cc syringe only |
153 |
150 |
$337.00 |
| A6216 |
Non-sterile gauze<=16 sq in |
53 |
48 |
$222.03 |
| A4452 |
Waterproof tape |
24 |
24 |
$158.46 |
| A4657 |
Syringe w/wo needle |
27 |
27 |
$67.70 |
| A9270 |
Non-covered item or service |
261 |
226 |
$0.00 |
| A4520 |
Incontinence garment anytype |
42 |
36 |
$0.00 |