| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
72,828 |
71,949 |
$5.40M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
25,864 |
25,542 |
$2.94M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
81,219 |
80,258 |
$2.66M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
17,951 |
17,694 |
$2.20M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
23,049 |
22,801 |
$2.07M |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
66,006 |
65,184 |
$2.06M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
12,172 |
12,159 |
$1.93M |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
78,514 |
77,569 |
$1.41M |
| T4541 |
Incontinence product, disposable underpad, large, each |
15,817 |
15,765 |
$1.30M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
34,081 |
33,645 |
$1.16M |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
14,515 |
14,494 |
$632K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
2,187 |
2,178 |
$498K |
| A4927 |
Gloves, non-sterile, per 100 |
91,174 |
90,110 |
$399K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,124 |
2,123 |
$398K |
| 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 |
1,550 |
1,549 |
$394K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,083 |
2,074 |
$375K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
4,660 |
4,649 |
$343K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
1,089 |
1,015 |
$288K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,393 |
3,378 |
$267K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
678 |
624 |
$211K |
| 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 |
2,044 |
2,012 |
$146K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,033 |
1,024 |
$140K |
| A5120 |
Skin barrier, wipes or swabs, each |
12,837 |
12,807 |
$121K |
| A4335 |
Incontinence supply; miscellaneous |
6,077 |
6,070 |
$94K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,345 |
1,184 |
$61K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
860 |
858 |
$52K |
| A6537 |
Gradient compression stocking, full length/chap style, 30-40 mmhg, each |
246 |
118 |
$51K |
| K0001 |
Standard wheelchair |
4,722 |
4,717 |
$45K |
| L0649 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
226 |
226 |
$40K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
450 |
448 |
$40K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
4,386 |
3,269 |
$31K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
313 |
311 |
$29K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
957 |
955 |
$26K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
652 |
649 |
$24K |
| A4402 |
Lubricant, per ounce |
3,897 |
3,889 |
$22K |
| K0003 |
Lightweight wheelchair |
935 |
934 |
$22K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
324 |
324 |
$20K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,602 |
907 |
$18K |
| 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 |
203 |
203 |
$17K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
479 |
479 |
$14K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
280 |
276 |
$12K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
383 |
383 |
$10K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
834 |
832 |
$10K |
| E0241 |
Bath tub wall rail, each |
257 |
255 |
$9K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
411 |
409 |
$9K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,526 |
1,526 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,617 |
5,607 |
$8K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
876 |
874 |
$6K |
| A4670 |
Automatic blood pressure monitor |
115 |
114 |
$6K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
779 |
779 |
$5K |
| E0156 |
Seat attachment, walker |
525 |
525 |
$4K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
65 |
64 |
$2K |
| E1399 |
Durable medical equipment, miscellaneous |
346 |
345 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
348 |
347 |
$2K |
| A4510 |
Surgical stockings full length, each |
13 |
12 |
$2K |
| E0244 |
Raised toilet seat |
70 |
70 |
$1K |
| K0006 |
Heavy duty wheelchair |
64 |
64 |
$1K |
| 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 |
12 |
12 |
$1K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
39 |
39 |
$831.74 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
41 |
24 |
$604.67 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
50 |
49 |
$366.94 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
205 |
205 |
$99.88 |