| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
26,375 |
25,124 |
$2.20M |
| T4541 |
Incontinence product, disposable underpad, large, each |
41,113 |
39,755 |
$1.48M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
15,814 |
15,240 |
$1.45M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12,450 |
11,892 |
$1.38M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
28,041 |
27,028 |
$1.30M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
14,770 |
14,232 |
$1.29M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,354 |
8,194 |
$959K |
| 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 |
11,687 |
10,583 |
$678K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,887 |
4,785 |
$648K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
6,544 |
6,391 |
$611K |
| A4927 |
Gloves, non-sterile, per 100 |
34,531 |
32,766 |
$586K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
4,628 |
4,604 |
$547K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,018 |
3,984 |
$542K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,115 |
2,027 |
$541K |
| 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 |
5,377 |
5,118 |
$538K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
3,991 |
3,701 |
$524K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,774 |
2,672 |
$485K |
| A4670 |
Automatic blood pressure monitor |
10,294 |
10,157 |
$482K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
4,109 |
4,004 |
$449K |
| 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 |
3,154 |
3,133 |
$315K |
| E0570 |
Nebulizer, with compressor |
6,372 |
6,228 |
$281K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
14,353 |
13,963 |
$231K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
3,700 |
3,272 |
$209K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
6,284 |
5,892 |
$193K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,461 |
1,441 |
$147K |
| E0245 |
Tub stool or bench |
4,147 |
4,028 |
$146K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,338 |
1,333 |
$141K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
3,134 |
2,847 |
$141K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
11,770 |
10,714 |
$136K |
| B4100 |
Food thickener, administered orally, per ounce |
1,666 |
1,616 |
$119K |
| K0001 |
Standard wheelchair |
6,968 |
6,788 |
$112K |
| 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 |
2,774 |
2,116 |
$111K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,819 |
3,621 |
$109K |
| 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 |
830 |
702 |
$108K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,836 |
2,444 |
$107K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
2,113 |
1,864 |
$103K |
| E0244 |
Raised toilet seat |
1,884 |
1,822 |
$78K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,427 |
1,259 |
$73K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
35,494 |
33,186 |
$71K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
2,144 |
1,964 |
$66K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,569 |
1,474 |
$66K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
1,064 |
1,026 |
$60K |
| E0241 |
Bath tub wall rail, each |
1,760 |
1,687 |
$56K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,232 |
1,192 |
$53K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
1,244 |
1,165 |
$53K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,888 |
1,664 |
$48K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,650 |
1,601 |
$48K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
854 |
779 |
$46K |
| E1399 |
Durable medical equipment, miscellaneous |
2,703 |
2,229 |
$45K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
549 |
481 |
$45K |
| E0156 |
Seat attachment, walker |
5,083 |
4,826 |
$44K |
| K0003 |
Lightweight wheelchair |
949 |
896 |
$41K |
| A4500 |
Surgical stockings below knee length, each |
1,555 |
1,439 |
$40K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,171 |
1,119 |
$37K |
| E0315 |
Bed accessory: board, table, or support device, any type |
755 |
735 |
$37K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,036 |
1,005 |
$31K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
3,358 |
3,249 |
$31K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
480 |
442 |
$30K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,146 |
1,119 |
$29K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
3,171 |
3,015 |
$28K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
490 |
469 |
$28K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
478 |
465 |
$25K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,496 |
1,470 |
$21K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,095 |
1,876 |
$21K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,437 |
3,111 |
$21K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
373 |
358 |
$19K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
406 |
391 |
$19K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
52 |
52 |
$18K |
| A4335 |
Incontinence supply; miscellaneous |
3,916 |
3,756 |
$17K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
125 |
117 |
$16K |
| K0007 |
Extra heavy duty wheelchair |
340 |
337 |
$16K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
81 |
81 |
$16K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,414 |
1,400 |
$15K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,088 |
2,635 |
$15K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
437 |
424 |
$13K |
| E0277 |
Powered pressure-reducing air mattress |
162 |
159 |
$12K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,737 |
1,493 |
$12K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,236 |
1,967 |
$11K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
343 |
342 |
$11K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
672 |
612 |
$11K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
378 |
375 |
$11K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,031 |
1,818 |
$9K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
187 |
173 |
$9K |
| A4217 |
Sterile water/saline, 500 ml |
1,173 |
1,019 |
$9K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
82 |
71 |
$8K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
292 |
250 |
$7K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
357 |
346 |
$7K |
| E0627 |
Seat lift mechanism, electric, any type |
105 |
105 |
$7K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,557 |
1,500 |
$6K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
849 |
818 |
$6K |
| A4402 |
Lubricant, per ounce |
1,098 |
1,073 |
$6K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
409 |
317 |
$6K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
874 |
740 |
$5K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
842 |
797 |
$5K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
697 |
673 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,809 |
1,575 |
$5K |
| 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 |
104 |
91 |
$5K |
| A4456 |
Adhesive remover, wipes, any type, each |
755 |
731 |
$5K |
| A4452 |
Tape, waterproof, per 18 square inches |
494 |
421 |
$4K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
246 |
206 |
$4K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
505 |
451 |
$4K |
| E0184 |
Dry pressure mattress |
120 |
117 |
$4K |
| 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 |
37 |
37 |
$2K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
573 |
529 |
$2K |
| A4495 |
Surgical stockings thigh length, each |
33 |
28 |
$2K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
94 |
78 |
$2K |
| 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 |
48 |
46 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
99 |
99 |
$2K |
| A4663 |
Blood pressure cuff only |
179 |
179 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,158 |
1,106 |
$1K |
| A4371 |
Ostomy skin barrier, powder, per oz |
541 |
472 |
$1K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
12 |
12 |
$1K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
44 |
44 |
$1K |
| A4332 |
Lubricant, individual sterile packet, each |
119 |
115 |
$1K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
627 |
585 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
419 |
385 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
616 |
553 |
$1K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
14 |
13 |
$857.48 |
| 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 |
29 |
29 |
$800.48 |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14 |
13 |
$768.77 |
| E0210 |
Electric heat pad, standard |
53 |
53 |
$729.06 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
18 |
15 |
$533.12 |
| E0605 |
Vaporizer, room type |
17 |
17 |
$355.77 |
| A4367 |
Ostomy belt, each |
93 |
91 |
$354.40 |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
15 |
14 |
$337.35 |
| A6260 |
Wound cleansers, any type, any size |
27 |
25 |
$254.41 |
| E0246 |
Transfer tub rail attachment |
13 |
13 |
$231.38 |
| A9281 |
Reaching/grabbing device, any type, any length, each |
13 |
12 |
$57.29 |