| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
149,458 |
149,199 |
$6.53M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
218,561 |
217,926 |
$6.25M |
| A4554 |
Disposable underpads, all sizes |
115,393 |
115,224 |
$3.44M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
47,116 |
47,031 |
$2.91M |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
13,363 |
9,767 |
$1.20M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
30,060 |
29,995 |
$813K |
| A4927 |
Gloves, non-sterile, per 100 |
132,632 |
132,432 |
$586K |
| 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 |
5,515 |
5,391 |
$561K |
| 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 |
5,639 |
5,622 |
$554K |
| 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 |
8,000 |
7,585 |
$523K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
7,921 |
5,840 |
$482K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,262 |
6,248 |
$463K |
| A4670 |
Automatic blood pressure monitor |
8,782 |
8,766 |
$427K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
6,028 |
4,355 |
$427K |
| 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 |
12,984 |
9,976 |
$395K |
| 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 |
12,667 |
9,694 |
$331K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
8,905 |
8,887 |
$330K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
13,285 |
13,218 |
$329K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
7,546 |
7,527 |
$268K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
7,553 |
7,527 |
$262K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
1,422 |
1,379 |
$196K |
| K0001 |
Standard wheelchair |
21,274 |
21,186 |
$176K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
2,314 |
2,221 |
$139K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
7,133 |
7,090 |
$134K |
| 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 |
2,360 |
2,145 |
$126K |
| K0002 |
Standard hemi (low seat) wheelchair |
10,461 |
10,406 |
$123K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
646 |
492 |
$108K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
4,921 |
4,911 |
$98K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
2,125 |
2,111 |
$93K |
| 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 |
1,949 |
1,504 |
$84K |
| E0245 |
Tub stool or bench |
3,130 |
3,124 |
$83K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
1,571 |
1,566 |
$66K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
11,454 |
11,406 |
$65K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,139 |
1,694 |
$64K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
2,780 |
2,772 |
$63K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
2,181 |
2,177 |
$45K |
| E0156 |
Seat attachment, walker |
6,766 |
6,731 |
$35K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,336 |
893 |
$34K |
| A4335 |
Incontinence supply; miscellaneous |
5,177 |
5,173 |
$34K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,628 |
1,614 |
$30K |
| E0241 |
Bath tub wall rail, each |
906 |
899 |
$30K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
9,852 |
9,779 |
$29K |
| E1399 |
Durable medical equipment, miscellaneous |
4,096 |
4,083 |
$29K |
| E0570 |
Nebulizer, with compressor |
4,401 |
4,389 |
$28K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
9,259 |
9,239 |
$27K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
158 |
157 |
$25K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
2,390 |
2,376 |
$23K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
762 |
748 |
$21K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
3,041 |
3,025 |
$20K |
| E0210 |
Electric heat pad, standard |
1,795 |
1,788 |
$14K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
376 |
324 |
$11K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
715 |
706 |
$10K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
183 |
181 |
$9K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
308 |
304 |
$9K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
394 |
180 |
$7K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
519 |
518 |
$7K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
770 |
759 |
$6K |
| A4402 |
Lubricant, per ounce |
1,235 |
1,226 |
$6K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,461 |
1,457 |
$5K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
277 |
275 |
$3K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
38 |
38 |
$2K |
| E0215 |
Electric heat pad, moist |
255 |
255 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
201 |
201 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
168 |
165 |
$2K |
| A4500 |
Surgical stockings below knee length, each |
41 |
41 |
$2K |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
66 |
66 |
$1K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
105 |
104 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
132 |
131 |
$982.32 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
170 |
168 |
$978.01 |
| E0243 |
Toilet rail, each |
13 |
13 |
$864.69 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
17 |
17 |
$748.80 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
12 |
12 |
$597.88 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
62 |
61 |
$377.20 |
| E0244 |
Raised toilet seat |
14 |
14 |
$263.92 |
| L8300 |
Truss, single with standard pad |
12 |
12 |
$241.59 |
| L1821 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf |
20 |
12 |
$202.95 |
| A4259 |
Lancets, per box of 100 |
81 |
80 |
$188.56 |
| E0325 |
Urinal; male, jug-type, any material |
25 |
25 |
$48.55 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
31 |
25 |
$27.77 |
| A4245 |
Alcohol wipes, per box |
13 |
13 |
$19.46 |
| A7015 |
Aerosol mask, used with dme nebulizer |
14 |
12 |
$10.12 |