| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
6,456 |
6,169 |
$386K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,698 |
1,661 |
$256K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,828 |
3,662 |
$241K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,802 |
2,678 |
$180K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,832 |
1,774 |
$177K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,888 |
1,802 |
$171K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,498 |
1,395 |
$160K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
790 |
771 |
$119K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,969 |
3,710 |
$119K |
| T4541 |
Incontinence product, disposable underpad, large, each |
4,350 |
4,156 |
$93K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,624 |
1,518 |
$78K |
| K0003 |
Lightweight wheelchair |
2,638 |
2,540 |
$67K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,112 |
2,026 |
$66K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,688 |
2,610 |
$53K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
452 |
430 |
$49K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
320 |
314 |
$46K |
| A4927 |
Gloves, non-sterile, per 100 |
2,716 |
2,581 |
$40K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,994 |
2,873 |
$36K |
| E0619 |
Apnea monitor, with recording feature |
216 |
213 |
$34K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
325 |
278 |
$20K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
313 |
288 |
$18K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
100 |
99 |
$15K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
556 |
552 |
$14K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
359 |
349 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
905 |
819 |
$10K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,982 |
1,937 |
$9K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
25 |
25 |
$7K |
| A4452 |
Tape, waterproof, per 18 square inches |
651 |
590 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
822 |
464 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
89 |
86 |
$6K |
| A7030 |
Full face mask used with positive airway pressure device, each |
58 |
57 |
$5K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
143 |
117 |
$5K |
| A7037 |
Tubing used with positive airway pressure device |
240 |
235 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
240 |
234 |
$4K |
| 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 |
51 |
50 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
287 |
277 |
$3K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
486 |
463 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,144 |
1,044 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,670 |
1,622 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
64 |
59 |
$2K |
| 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 |
25 |
24 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
93 |
88 |
$1K |
| K0001 |
Standard wheelchair |
24 |
24 |
$768.20 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
12 |
12 |
$701.74 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
157 |
149 |
$645.69 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
38 |
37 |
$601.62 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
27 |
26 |
$476.91 |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
13 |
12 |
$322.00 |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
185 |
165 |
$312.35 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
13 |
12 |
$308.44 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
82 |
78 |
$256.68 |
| A4402 |
Lubricant, per ounce |
54 |
51 |
$248.13 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
33 |
29 |
$218.12 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
190 |
158 |
$181.97 |
| A5120 |
Skin barrier, wipes or swabs, each |
13 |
13 |
$66.04 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
36 |
36 |
$14.87 |
| A4217 |
Sterile water/saline, 500 ml |
39 |
39 |
$0.00 |
| A4354 |
Insertion tray with drainage bag but without catheter |
14 |
12 |
$0.00 |