| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
54,764 |
53,210 |
$8.90M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
46,128 |
44,328 |
$5.41M |
| 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 |
40,720 |
38,692 |
$4.04M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
32,600 |
31,574 |
$3.04M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
31,331 |
30,260 |
$2.91M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
27,214 |
26,190 |
$2.53M |
| T4541 |
Incontinence product, disposable underpad, large, each |
99,764 |
97,554 |
$2.31M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
9,897 |
9,630 |
$2.07M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
17,214 |
16,571 |
$1.79M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
49,301 |
47,554 |
$1.72M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
41,906 |
41,115 |
$1.60M |
| A4927 |
Gloves, non-sterile, per 100 |
85,926 |
81,050 |
$1.35M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
15,876 |
15,268 |
$1.25M |
| E0570 |
Nebulizer, with compressor |
22,384 |
21,633 |
$1.22M |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
10,303 |
9,954 |
$1.00M |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
8,193 |
7,788 |
$946K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
8,874 |
8,544 |
$866K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
6,729 |
6,425 |
$742K |
| A4670 |
Automatic blood pressure monitor |
10,485 |
10,326 |
$534K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
4,081 |
3,811 |
$449K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,267 |
3,118 |
$384K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,141 |
3,038 |
$305K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
8,082 |
7,521 |
$259K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
3,748 |
3,622 |
$175K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
1,295 |
1,241 |
$160K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,372 |
2,078 |
$125K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
933 |
848 |
$119K |
| A4335 |
Incontinence supply; miscellaneous |
1,500 |
1,415 |
$103K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
880 |
870 |
$96K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,851 |
1,602 |
$83K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,862 |
2,767 |
$78K |
| K0001 |
Standard wheelchair |
3,757 |
3,638 |
$77K |
| E0555 |
Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter |
2,120 |
2,093 |
$72K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
890 |
874 |
$71K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,705 |
1,631 |
$64K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
3,115 |
3,056 |
$60K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
35,427 |
34,550 |
$59K |
| 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 |
1,034 |
940 |
$51K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
310 |
308 |
$51K |
| E1399 |
Durable medical equipment, miscellaneous |
347 |
314 |
$43K |
| E0156 |
Seat attachment, walker |
3,764 |
3,660 |
$39K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
590 |
581 |
$37K |
| A4259 |
Lancets, per box of 100 |
7,657 |
7,285 |
$36K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
94 |
94 |
$36K |
| A7015 |
Aerosol mask, used with dme nebulizer |
30,084 |
29,335 |
$28K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
2,305 |
2,248 |
$23K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
100 |
99 |
$22K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
788 |
784 |
$19K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
687 |
669 |
$16K |
| E0607 |
Home blood glucose monitor |
337 |
326 |
$12K |
| K0003 |
Lightweight wheelchair |
343 |
339 |
$11K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
159 |
149 |
$10K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
42 |
40 |
$8K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
66 |
63 |
$7K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
88 |
84 |
$6K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
67 |
63 |
$5K |
| 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 |
138 |
90 |
$5K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
60 |
57 |
$4K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
148 |
101 |
$4K |
| 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 |
147 |
147 |
$4K |
| 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 |
102 |
101 |
$4K |
| E0605 |
Vaporizer, room type |
188 |
183 |
$3K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
438 |
433 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
222 |
166 |
$3K |
| E0241 |
Bath tub wall rail, each |
273 |
254 |
$3K |
| E0244 |
Raised toilet seat |
57 |
54 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
151 |
146 |
$1K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
14 |
14 |
$1K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
12 |
12 |
$979.59 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,906 |
1,722 |
$926.51 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
43 |
40 |
$458.06 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
16 |
14 |
$93.40 |
| A4217 |
Sterile water/saline, 500 ml |
12 |
12 |
$90.86 |
| A4332 |
Lubricant, individual sterile packet, each |
12 |
12 |
$59.40 |