| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Special med equip, noswaiver |
32,607 |
23,210 |
$6.94M |
| T4527 |
Adult size pull-on lg |
18,526 |
18,485 |
$2.12M |
| T4528 |
Adult size pull-on xl |
13,185 |
13,159 |
$1.89M |
| A4554 |
Disposable underpads |
46,569 |
46,415 |
$1.50M |
| A4253 |
Blood glucose/reagent strips |
49,322 |
48,588 |
$1.35M |
| T4526 |
Adult size pull-on med |
11,277 |
11,246 |
$1.08M |
| E0260 |
Hosp bed semi-electr w/ matt |
2,505 |
2,449 |
$989K |
| T4535 |
Disposable liner/shield/pad |
24,394 |
24,030 |
$940K |
| E0240 |
Bath/shower chair |
9,702 |
9,538 |
$896K |
| T4544 |
Adlt disp und/pull on abv xl |
3,027 |
3,021 |
$548K |
| K0001 |
Standard wheelchair |
3,756 |
3,598 |
$493K |
| A4670 |
Automatic bp monitor, dial |
9,140 |
9,021 |
$482K |
| B4150 |
Ef complet w/intact nutrient |
2,004 |
1,898 |
$389K |
| T2028 |
Special supply, nos waiver |
1,591 |
1,542 |
$386K |
| A4335 |
Incontinence supply |
69,425 |
69,297 |
$383K |
| E0143 |
Walker folding wheeled w/o s |
5,999 |
5,875 |
$363K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,005 |
926 |
$327K |
| T4524 |
Adult size brief/diaper xl |
2,343 |
2,337 |
$305K |
| T4523 |
Adult size brief/diaper lg |
3,213 |
3,205 |
$285K |
| T4525 |
Adult size pull-on sm |
3,537 |
3,525 |
$282K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
997 |
961 |
$281K |
| B4035 |
Enteral feed supp pump per d |
1,059 |
965 |
$270K |
| A4375 |
Drainable plastic pch w fcpl |
597 |
554 |
$256K |
| K0007 |
Extra heavy duty wheelchair |
1,254 |
1,212 |
$254K |
| T4543 |
Adult disp brief/diap abv xl |
1,530 |
1,528 |
$240K |
| A4259 |
Lancets per box |
31,867 |
31,415 |
$227K |
| T4534 |
Youth size pull-on |
1,998 |
1,969 |
$188K |
| A6212 |
Foam drg <=16 sq in w/border |
822 |
786 |
$181K |
| K0006 |
Heavy duty wheelchair |
1,454 |
1,376 |
$178K |
| E0630 |
Patient lift hydraulic |
889 |
862 |
$174K |
| E1399 |
Durable medical equipment mi |
3,460 |
2,599 |
$169K |
| E0149 |
Heavy duty wheeled walker |
1,341 |
1,319 |
$163K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
901 |
840 |
$154K |
| K0003 |
Lightweight wheelchair |
1,083 |
1,054 |
$154K |
| E0303 |
Hosp bed hvy dty xtra wide |
492 |
473 |
$144K |
| B9998 |
Enteral supp not otherwise c |
1,808 |
1,412 |
$141K |
| E0163 |
Commode chair with fixed arm |
1,950 |
1,897 |
$129K |
| E0247 |
Trans bench w/wo comm open |
1,606 |
1,577 |
$125K |
| T4522 |
Adult size brief/diaper med |
1,369 |
1,359 |
$119K |
| A4452 |
Waterproof tape |
2,237 |
2,075 |
$105K |
| E1260 |
Wheelchair lightwt foot rest |
156 |
156 |
$105K |
| A4351 |
Straight tip urine catheter |
460 |
450 |
$89K |
| E0246 |
Transfer tub rail attachment |
1,990 |
1,956 |
$86K |
| B4034 |
Enter feed supkit syr by day |
1,034 |
934 |
$77K |
| A6260 |
Wound cleanser any type/size |
833 |
809 |
$56K |
| E0445 |
Oximeter non-invasive |
241 |
235 |
$50K |
| E0243 |
Toilet rail |
451 |
445 |
$47K |
| A6197 |
Alginate drsg >16 <=48 sq in |
123 |
116 |
$46K |
| A4245 |
Alcohol wipes per box |
31,243 |
30,831 |
$46K |
| E0244 |
Toilet seat raised |
1,499 |
1,469 |
$40K |
| K0739 |
Repair/svc dme non-oxygen eq |
999 |
958 |
$39K |
| B4161 |
Ef ped hydrolyzed/amino acid |
42 |
37 |
$36K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,283 |
2,148 |
$35K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
1,183 |
1,133 |
$35K |
| E0105 |
Cane adjust/fixed quad/3 pro |
1,228 |
1,202 |
$35K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
213 |
206 |
$35K |
| B4149 |
Ef blenderized foods |
46 |
44 |
$30K |
| A6402 |
Sterile gauze <= 16 sq in |
2,486 |
2,392 |
$30K |
| E0248 |
Hdtrans bench w/wo comm open |
169 |
163 |
$26K |
| A4377 |
Drainable plstic pch w/o fp |
199 |
196 |
$24K |
| E0100 |
Cane adjust/fixed with tip |
1,853 |
1,816 |
$22K |
| T4533 |
Youth size brief/diaper |
164 |
163 |
$13K |
| A4217 |
Sterile water/saline, 500 ml |
1,652 |
1,586 |
$13K |
| A4322 |
Irrigation syringe |
1,002 |
767 |
$12K |
| A4338 |
Indwelling catheter latex |
741 |
675 |
$12K |
| E0635 |
Patient lift electric |
27 |
24 |
$12K |
| A4357 |
Bedside drainage bag |
992 |
884 |
$12K |
| A4450 |
Non-waterproof tape |
1,549 |
1,490 |
$11K |
| E0570 |
Nebulizer with compression |
158 |
152 |
$10K |
| A6250 |
Skin seal protect moisturizr |
2,020 |
1,990 |
$10K |
| A4349 |
Disposable male external cat |
185 |
182 |
$9K |
| E0185 |
Gel pressure mattress pad |
100 |
98 |
$8K |
| E1031 |
Rollabout chair with casters |
284 |
274 |
$8K |
| E0168 |
Heavyduty/wide commode chair |
80 |
79 |
$7K |
| A5120 |
Skin barrier, wipe or swab |
732 |
638 |
$7K |
| A7000 |
Disposable canister for pump |
484 |
445 |
$7K |
| A4927 |
Non-sterile gloves |
1,066 |
1,030 |
$7K |
| A4628 |
Oropharyngeal suction cath |
520 |
474 |
$7K |
| A4402 |
Lubricant per ounce |
351 |
348 |
$6K |
| A4310 |
Insert tray w/o bag/cath |
529 |
465 |
$5K |
| A7002 |
Tubing used w suction pump |
553 |
508 |
$3K |
| A4406 |
Pectin based ostomy paste |
133 |
130 |
$3K |
| A4258 |
Lancet device each |
227 |
227 |
$3K |
| E2601 |
Gen w/c cushion wdth < 22 in |
76 |
74 |
$2K |
| A4256 |
Calibrator solution/chips |
213 |
213 |
$2K |
| A6196 |
Alginate dressing <=16 sq in |
13 |
13 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
26 |
26 |
$2K |
| A4629 |
Tracheostomy care kit |
24 |
24 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
71 |
63 |
$727.79 |
| E0978 |
W/c acc,saf belt pelv strap |
25 |
25 |
$679.68 |
| A4657 |
Syringe w/wo needle |
187 |
181 |
$549.13 |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
14 |
12 |
$499.89 |
| A7003 |
Nebulizer administration set |
199 |
198 |
$477.63 |
| E0245 |
Tub stool or bench |
13 |
13 |
$464.50 |
| E0325 |
Urinal male jug-type |
51 |
51 |
$316.40 |
| A7015 |
Aerosol mask used w nebulize |
111 |
110 |
$153.27 |
| E0607 |
Blood glucose monitor home |
262 |
262 |
$0.00 |
| A9270 |
Non-covered item or service |
134 |
121 |
$0.00 |