| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Ef complet w/intact nutrient |
26,375 |
25,124 |
$2.20M |
| T4541 |
Large disposable underpad |
41,113 |
39,755 |
$1.48M |
| T4527 |
Adult size pull-on lg |
15,814 |
15,240 |
$1.45M |
| T4528 |
Adult size pull-on xl |
12,450 |
11,892 |
$1.38M |
| T4535 |
Disposable liner/shield/pad |
28,041 |
27,028 |
$1.30M |
| T4526 |
Adult size pull-on med |
14,770 |
14,232 |
$1.29M |
| T4523 |
Adult size brief/diaper lg |
8,354 |
8,194 |
$959K |
| B4154 |
Ef spec metabolic noninherit |
11,687 |
10,583 |
$678K |
| T4524 |
Adult size brief/diaper xl |
4,887 |
4,785 |
$648K |
| T4522 |
Adult size brief/diaper med |
6,544 |
6,391 |
$611K |
| A4927 |
Non-sterile gloves |
34,531 |
32,766 |
$586K |
| T4530 |
Ped size brief/diaper lg |
4,628 |
4,604 |
$547K |
| T4534 |
Youth size pull-on |
4,018 |
3,984 |
$542K |
| T4543 |
Adult disp brief/diap abv xl |
2,115 |
2,027 |
$541K |
| B4152 |
Ef calorie dense>/=1.5kcal |
5,377 |
5,118 |
$538K |
| A4351 |
Straight tip urine catheter |
3,991 |
3,701 |
$524K |
| T4544 |
Adlt disp und/pull on abv xl |
2,774 |
2,672 |
$485K |
| A4670 |
Automatic bp monitor, dial |
10,294 |
10,157 |
$482K |
| T4525 |
Adult size pull-on sm |
4,109 |
4,004 |
$449K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,154 |
3,133 |
$315K |
| E0570 |
Nebulizer with compression |
6,372 |
6,228 |
$281K |
| T4537 |
Reusable underpad bed size |
14,353 |
13,963 |
$231K |
| A6530 |
Compression stocking bk18-30 |
3,700 |
3,272 |
$209K |
| E0143 |
Walker folding wheeled w/o s |
6,284 |
5,892 |
$193K |
| T4521 |
Adult size brief/diaper sm |
1,461 |
1,441 |
$147K |
| E0245 |
Tub stool or bench |
4,147 |
4,028 |
$146K |
| T4533 |
Youth size brief/diaper |
1,338 |
1,333 |
$141K |
| A4385 |
Ost skn barrier sld ext wear |
3,134 |
2,847 |
$141K |
| A9286 |
Any hygienic item, device |
11,770 |
10,714 |
$136K |
| B4100 |
Food thickener oral |
1,666 |
1,616 |
$119K |
| K0001 |
Standard wheelchair |
6,968 |
6,788 |
$112K |
| A5500 |
Diab shoe for density insert |
2,774 |
2,116 |
$111K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,819 |
3,621 |
$109K |
| A6197 |
Alginate drsg >16 <=48 sq in |
830 |
702 |
$108K |
| L3908 |
Who cock-up nonmolde pre ots |
2,836 |
2,444 |
$107K |
| A5512 |
Multi den insert direct form |
2,113 |
1,864 |
$103K |
| E0244 |
Toilet seat raised |
1,884 |
1,822 |
$78K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,427 |
1,259 |
$73K |
| A9901 |
Delivery/set up/dispensing |
35,494 |
33,186 |
$71K |
| A4362 |
Solid skin barrier |
2,144 |
1,964 |
$66K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,569 |
1,474 |
$66K |
| A4424 |
Ost pch drain w bar & filter |
1,064 |
1,026 |
$60K |
| E0241 |
Bath tub wall rail |
1,760 |
1,687 |
$56K |
| A4349 |
Disposable male external cat |
1,232 |
1,192 |
$53K |
| E0265 |
Hosp bed total electr w/ mat |
1,244 |
1,165 |
$53K |
| E0163 |
Commode chair with fixed arm |
1,888 |
1,664 |
$48K |
| A5063 |
Drain ostomy pouch w/flange |
1,650 |
1,601 |
$48K |
| A4407 |
Ext wear ost skn barr <=4sq" |
854 |
779 |
$46K |
| E1399 |
Durable medical equipment mi |
2,703 |
2,229 |
$45K |
| A6212 |
Foam drg <=16 sq in w/border |
549 |
481 |
$45K |
| E0156 |
Walker seat attachment |
5,083 |
4,826 |
$44K |
| K0003 |
Lightweight wheelchair |
949 |
896 |
$41K |
| A4500 |
Below knee surgical stocking |
1,555 |
1,439 |
$40K |
| A5061 |
Pouch drainable w barrier at |
1,171 |
1,119 |
$37K |
| E0315 |
Bed accessory brd/tbl/supprt |
755 |
735 |
$37K |
| A4425 |
Ost pch drain for barrier fl |
1,036 |
1,005 |
$31K |
| E0100 |
Cane adjust/fixed with tip |
3,358 |
3,249 |
$31K |
| E0247 |
Trans bench w/wo comm open |
480 |
442 |
$30K |
| E0630 |
Patient lift hydraulic |
1,146 |
1,119 |
$29K |
| E1038 |
Transport chair pt wt<=300lb |
3,171 |
3,015 |
$28K |
| E0240 |
Bath/shower chair |
490 |
469 |
$28K |
| L1820 |
Ko elas w/ condyle pads & jo |
478 |
465 |
$25K |
| E0261 |
Hosp bed semi-electr w/o mat |
1,496 |
1,470 |
$21K |
| A4406 |
Pectin based ostomy paste |
2,095 |
1,876 |
$21K |
| A4357 |
Bedside drainage bag |
3,437 |
3,111 |
$21K |
| E0303 |
Hosp bed hvy dty xtra wide |
373 |
358 |
$19K |
| L1812 |
Ko elastic w/joints pre ots |
406 |
391 |
$19K |
| A4353 |
Intermittent urinary cath |
52 |
52 |
$18K |
| A4335 |
Incontinence supply |
3,916 |
3,756 |
$17K |
| E0603 |
Electric breast pump |
125 |
117 |
$16K |
| K0007 |
Extra heavy duty wheelchair |
340 |
337 |
$16K |
| A9900 |
Supply/accessory/service |
81 |
81 |
$16K |
| A7005 |
Nondisposable nebulizer set |
1,414 |
1,400 |
$15K |
| A6402 |
Sterile gauze <= 16 sq in |
3,088 |
2,635 |
$15K |
| E0149 |
Heavy duty wheeled walker |
437 |
424 |
$13K |
| E0277 |
Powered pres-redu air mattrs |
162 |
159 |
$12K |
| A4338 |
Indwelling catheter latex |
1,737 |
1,493 |
$12K |
| A5120 |
Skin barrier, wipe or swab |
2,236 |
1,967 |
$11K |
| E0118 |
Crutch substitute |
343 |
342 |
$11K |
| A6446 |
Conform band s w>=3" <5"/yd |
672 |
612 |
$11K |
| E0114 |
Crutch underarm pair no wood |
378 |
375 |
$11K |
| A4358 |
Urinary leg or abdomen bag |
2,031 |
1,818 |
$9K |
| B4102 |
Ef adult fluids and electro |
187 |
173 |
$9K |
| A4217 |
Sterile water/saline, 500 ml |
1,173 |
1,019 |
$9K |
| A6533 |
Gc stocking thighlngth 18-30 |
82 |
71 |
$8K |
| A4432 |
Os pch urine w bar/fange/tap |
292 |
250 |
$7K |
| E0105 |
Cane adjust/fixed quad/3 pro |
357 |
346 |
$7K |
| E0627 |
Seat lift mech, electric any |
105 |
105 |
$7K |
| K0195 |
Elevating whlchair leg rests |
1,557 |
1,500 |
$6K |
| A4394 |
Ostomy pouch liq deodorant |
849 |
818 |
$6K |
| A4402 |
Lubricant per ounce |
1,098 |
1,073 |
$6K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
409 |
317 |
$6K |
| A6216 |
Non-sterile gauze<=16 sq in |
874 |
740 |
$5K |
| A6250 |
Skin seal protect moisturizr |
842 |
797 |
$5K |
| E0181 |
Press pad alternating w/ pum |
697 |
673 |
$5K |
| A4450 |
Non-waterproof tape |
1,809 |
1,575 |
$5K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
104 |
91 |
$5K |
| A4456 |
Adhesive remover, wipes |
755 |
731 |
$5K |
| A4452 |
Waterproof tape |
494 |
421 |
$4K |
| E0190 |
Positioning cushion |
246 |
206 |
$4K |
| E0990 |
Wheelchair elevating leg res |
505 |
451 |
$4K |
| E0184 |
Dry pressure mattress |
120 |
117 |
$4K |
| B4155 |
Ef incomplete/modular |
37 |
37 |
$2K |
| A4310 |
Insert tray w/o bag/cath |
573 |
529 |
$2K |
| A4495 |
Thigh length surg stocking |
33 |
28 |
$2K |
| A9999 |
Dme supply or accessory, nos |
94 |
78 |
$2K |
| L1810 |
Ko elastic with joints |
48 |
46 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
99 |
99 |
$2K |
| A4663 |
Dialysis blood pressure cuff |
179 |
179 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
1,158 |
1,106 |
$1K |
| A4371 |
Skin barrier powder per oz |
541 |
472 |
$1K |
| L3809 |
Whfo w/o joints pre ots |
12 |
12 |
$1K |
| E0135 |
Walker folding adjust/fixed |
44 |
44 |
$1K |
| A4332 |
Lube sterile packet |
119 |
115 |
$1K |
| A4369 |
Skin barrier liquid per oz |
627 |
585 |
$1K |
| A4216 |
Sterile water/saline, 10 ml |
419 |
385 |
$1K |
| A7003 |
Nebulizer administration set |
616 |
553 |
$1K |
| A4390 |
Drainable pch ex wear convex |
14 |
13 |
$857.48 |
| L0625 |
Lo flex l1-below l5 pre ots |
29 |
29 |
$800.48 |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
14 |
13 |
$768.77 |
| E0210 |
Electric heat pad standard |
53 |
53 |
$729.06 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
18 |
15 |
$533.12 |
| E0605 |
Vaporizer room type |
17 |
17 |
$355.77 |
| A4367 |
Ostomy belt |
93 |
91 |
$354.40 |
| A6248 |
Hydrogel drsg gel filler |
15 |
14 |
$337.35 |
| A6260 |
Wound cleanser any type/size |
27 |
25 |
$254.41 |
| E0246 |
Transfer tub rail attachment |
13 |
13 |
$231.38 |
| A9281 |
Reaching/grabbing device |
13 |
12 |
$57.29 |