| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
7,376 |
7,083 |
$720K |
| A4554 |
Disposable underpads, all sizes |
14,564 |
13,834 |
$703K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,374 |
5,206 |
$659K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,705 |
4,486 |
$606K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,304 |
3,164 |
$309K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,541 |
1,469 |
$207K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,581 |
1,519 |
$163K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,197 |
1,118 |
$114K |
| A4927 |
Gloves, non-sterile, per 100 |
8,236 |
7,931 |
$97K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,620 |
1,523 |
$53K |
| K0003 |
Lightweight wheelchair |
1,756 |
1,668 |
$51K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
514 |
512 |
$45K |
| A6214 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
379 |
347 |
$38K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
660 |
619 |
$22K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, 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, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
140 |
140 |
$21K |
| A4670 |
Automatic blood pressure monitor |
636 |
619 |
$16K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,878 |
1,796 |
$15K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
304 |
288 |
$9K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
363 |
348 |
$9K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
90 |
86 |
$8K |
| E1392 |
Portable oxygen concentrator, rental |
551 |
513 |
$4K |
| E1353 |
Regulator |
43 |
41 |
$3K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
15 |
12 |
$2K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
77 |
76 |
$2K |
| E0245 |
Tub stool or bench |
40 |
39 |
$2K |
| 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 |
13 |
13 |
$2K |
| E0156 |
Seat attachment, walker |
212 |
192 |
$2K |
| L8310 |
Truss, double with standard pads |
16 |
16 |
$1K |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
81 |
80 |
$1K |
| A4452 |
Tape, waterproof, per 18 square inches |
71 |
65 |
$467.80 |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
16 |
16 |
$407.82 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
14 |
13 |
$321.50 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
14 |
14 |
$149.81 |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
13 |
12 |
$4.75 |
| 0004A |
|
22 |
22 |
$0.00 |
| 0124A |
|
20 |
20 |
$0.00 |
| 0003A |
|
15 |
15 |
$0.00 |
| M0201 |
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
63 |
60 |
$0.00 |