| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
32,607 |
23,210 |
$6.94M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
18,526 |
18,485 |
$2.12M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
13,185 |
13,159 |
$1.89M |
| A4554 |
Disposable underpads, all sizes |
46,569 |
46,415 |
$1.50M |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
49,322 |
48,588 |
$1.35M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
11,277 |
11,246 |
$1.08M |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,505 |
2,449 |
$989K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
24,394 |
24,030 |
$940K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
9,702 |
9,538 |
$896K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
3,027 |
3,021 |
$548K |
| K0001 |
Standard wheelchair |
3,756 |
3,598 |
$493K |
| A4670 |
Automatic blood pressure monitor |
9,140 |
9,021 |
$482K |
| 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 |
2,004 |
1,898 |
$389K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
1,591 |
1,542 |
$386K |
| A4335 |
Incontinence supply; miscellaneous |
69,425 |
69,297 |
$383K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
5,999 |
5,875 |
$363K |
| 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 |
1,005 |
926 |
$327K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,343 |
2,337 |
$305K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,213 |
3,205 |
$285K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,537 |
3,525 |
$282K |
| 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 |
997 |
961 |
$281K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,059 |
965 |
$270K |
| A4375 |
Ostomy pouch, drainable, with faceplate attached, plastic, each |
597 |
554 |
$256K |
| K0007 |
Extra heavy duty wheelchair |
1,254 |
1,212 |
$254K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,530 |
1,528 |
$240K |
| A4259 |
Lancets, per box of 100 |
31,867 |
31,415 |
$227K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,998 |
1,969 |
$188K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
822 |
786 |
$181K |
| K0006 |
Heavy duty wheelchair |
1,454 |
1,376 |
$178K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
889 |
862 |
$174K |
| E1399 |
Durable medical equipment, miscellaneous |
3,460 |
2,599 |
$169K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,341 |
1,319 |
$163K |
| 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 |
901 |
840 |
$154K |
| K0003 |
Lightweight wheelchair |
1,083 |
1,054 |
$154K |
| 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 |
492 |
473 |
$144K |
| B9998 |
Noc for enteral supplies |
1,808 |
1,412 |
$141K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,950 |
1,897 |
$129K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
1,606 |
1,577 |
$125K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,369 |
1,359 |
$119K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,237 |
2,075 |
$105K |
| E1260 |
Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest |
156 |
156 |
$105K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
460 |
450 |
$89K |
| E0246 |
Transfer tub rail attachment |
1,990 |
1,956 |
$86K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,034 |
934 |
$77K |
| A6260 |
Wound cleansers, any type, any size |
833 |
809 |
$56K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
241 |
235 |
$50K |
| E0243 |
Toilet rail, each |
451 |
445 |
$47K |
| 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 |
123 |
116 |
$46K |
| A4245 |
Alcohol wipes, per box |
31,243 |
30,831 |
$46K |
| E0244 |
Raised toilet seat |
1,499 |
1,469 |
$40K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
999 |
958 |
$39K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
42 |
37 |
$36K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,283 |
2,148 |
$35K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
1,183 |
1,133 |
$35K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
1,228 |
1,202 |
$35K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
213 |
206 |
$35K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
46 |
44 |
$30K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,486 |
2,392 |
$30K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
169 |
163 |
$26K |
| A4377 |
Ostomy pouch, drainable, for use on faceplate, plastic, each |
199 |
196 |
$24K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,853 |
1,816 |
$22K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
164 |
163 |
$13K |
| A4217 |
Sterile water/saline, 500 ml |
1,652 |
1,586 |
$13K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,002 |
767 |
$12K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
741 |
675 |
$12K |
| E0635 |
Patient lift, electric with seat or sling |
27 |
24 |
$12K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
992 |
884 |
$12K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,549 |
1,490 |
$11K |
| E0570 |
Nebulizer, with compressor |
158 |
152 |
$10K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
2,020 |
1,990 |
$10K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
185 |
182 |
$9K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
100 |
98 |
$8K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
284 |
274 |
$8K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
80 |
79 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
732 |
638 |
$7K |
| A7000 |
Canister, disposable, used with suction pump, each |
484 |
445 |
$7K |
| A4927 |
Gloves, non-sterile, per 100 |
1,066 |
1,030 |
$7K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
520 |
474 |
$7K |
| A4402 |
Lubricant, per ounce |
351 |
348 |
$6K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
529 |
465 |
$5K |
| A7002 |
Tubing, used with suction pump, each |
553 |
508 |
$3K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
133 |
130 |
$3K |
| A4258 |
Spring-powered device for lancet, each |
227 |
227 |
$3K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
76 |
74 |
$2K |
| A4256 |
Normal, low and high calibrator solution / chips |
213 |
213 |
$2K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
13 |
13 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
26 |
26 |
$2K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
24 |
24 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
71 |
63 |
$727.79 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
25 |
25 |
$679.68 |
| A4657 |
Syringe, with or without needle, each |
187 |
181 |
$549.13 |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
14 |
12 |
$499.89 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
199 |
198 |
$477.63 |
| E0245 |
Tub stool or bench |
13 |
13 |
$464.50 |
| E0325 |
Urinal; male, jug-type, any material |
51 |
51 |
$316.40 |
| A7015 |
Aerosol mask, used with dme nebulizer |
111 |
110 |
$153.27 |
| E0607 |
Home blood glucose monitor |
262 |
262 |
$0.00 |
| A9270 |
Non-covered item or service |
134 |
121 |
$0.00 |