| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
20,031 |
19,788 |
$1.56M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
6,391 |
6,387 |
$925K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
18,032 |
17,758 |
$559K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
6,056 |
5,997 |
$507K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
14,900 |
14,686 |
$465K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,074 |
3,007 |
$404K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,820 |
3,766 |
$317K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,954 |
2,879 |
$290K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,802 |
1,783 |
$232K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
13,130 |
12,871 |
$218K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,653 |
2,634 |
$205K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
674 |
665 |
$188K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
816 |
809 |
$103K |
| E1392 |
Portable oxygen concentrator, rental |
2,006 |
1,987 |
$101K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,148 |
3,074 |
$96K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,260 |
2,239 |
$73K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,106 |
2,056 |
$72K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
1,546 |
1,544 |
$64K |
| 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 |
1,473 |
1,435 |
$64K |
| A4402 |
Lubricant, per ounce |
12,009 |
11,725 |
$56K |
| A4927 |
Gloves, non-sterile, per 100 |
14,752 |
14,408 |
$54K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
1,194 |
1,193 |
$49K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
351 |
349 |
$34K |
| E0570 |
Nebulizer, with compressor |
888 |
882 |
$27K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,470 |
1,456 |
$26K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,136 |
2,040 |
$24K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
96 |
96 |
$22K |
| K0001 |
Standard wheelchair |
1,713 |
1,565 |
$15K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
413 |
408 |
$13K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
327 |
306 |
$12K |
| E0602 |
Breast pump, manual, any type |
351 |
349 |
$11K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
36 |
36 |
$11K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,039 |
1,000 |
$9K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
281 |
280 |
$9K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
158 |
156 |
$7K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
206 |
201 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
232 |
230 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
526 |
518 |
$4K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
37 |
36 |
$4K |
| A4670 |
Automatic blood pressure monitor |
89 |
89 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
119 |
119 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,321 |
1,299 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
228 |
215 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
366 |
359 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
366 |
351 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
52 |
52 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
157 |
142 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
823 |
793 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
722 |
710 |
$1K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
29 |
27 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
136 |
124 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
426 |
406 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
516 |
470 |
$917.63 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14 |
13 |
$762.78 |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
72 |
66 |
$524.06 |
| E0156 |
Seat attachment, walker |
63 |
63 |
$421.23 |
| A7030 |
Full face mask used with positive airway pressure device, each |
14 |
14 |
$402.13 |
| K0004 |
High strength, lightweight wheelchair |
39 |
37 |
$282.87 |
| A4456 |
Adhesive remover, wipes, any type, each |
64 |
62 |
$199.72 |
| A5120 |
Skin barrier, wipes or swabs, each |
62 |
61 |
$166.64 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
14 |
14 |
$96.05 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
12 |
12 |
$54.83 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
483 |
448 |
$52.73 |