| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4575 |
Topical hyperbaric oxygen chamber, disposable |
1,643 |
1,529 |
$8.15M |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
56,640 |
28,393 |
$4.11M |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
76,265 |
38,069 |
$3.68M |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
39,651 |
19,896 |
$2.96M |
| A4554 |
Disposable underpads, all sizes |
73,642 |
73,173 |
$2.82M |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
15,974 |
7,985 |
$2.79M |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
35,360 |
17,691 |
$2.57M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
25,067 |
24,818 |
$2.19M |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
39,616 |
19,871 |
$2.03M |
| L3410 |
Metatarsal bar wedge, between sole |
44,725 |
22,375 |
$2.00M |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
10,193 |
5,167 |
$1.88M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
3,269 |
2,910 |
$1.87M |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
28,392 |
14,236 |
$1.71M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
53,783 |
53,528 |
$1.63M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
19,466 |
19,412 |
$1.52M |
| 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 |
17,475 |
8,778 |
$1.30M |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
9,004 |
4,617 |
$1.05M |
| L3370 |
Sole wedge, between sole |
43,518 |
21,760 |
$1.04M |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
30,358 |
15,282 |
$1.02M |
| L2330 |
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
3,423 |
1,711 |
$1.01M |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
3,428 |
1,713 |
$969K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
36,834 |
36,523 |
$800K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
7,226 |
3,655 |
$747K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
9,857 |
4,929 |
$746K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
12,422 |
6,160 |
$680K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,594 |
3,538 |
$658K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
25,092 |
24,882 |
$642K |
| L3485 |
Heel, pad, removable for spur |
24,617 |
12,316 |
$585K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
14,610 |
7,305 |
$552K |
| 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 |
2,654 |
2,649 |
$499K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
8,165 |
8,099 |
$496K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
7,634 |
3,792 |
$484K |
| L0627 |
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 item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
2,274 |
2,269 |
$483K |
| L3060 |
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
12,701 |
6,362 |
$413K |
| L2112 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
1,717 |
1,714 |
$403K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
3,463 |
3,458 |
$398K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
16,148 |
8,083 |
$386K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
6,653 |
3,355 |
$332K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
587 |
510 |
$311K |
| L3710 |
Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf |
5,844 |
2,930 |
$304K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
10,885 |
5,450 |
$258K |
| L1930 |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
1,545 |
843 |
$215K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,357 |
2,348 |
$197K |
| L3480 |
Heel, pad and depression for spur |
12,929 |
6,522 |
$194K |
| E0570 |
Nebulizer, with compressor |
2,359 |
2,329 |
$184K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 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 |
396 |
390 |
$182K |
| L3390 |
Outflare wedge |
7,520 |
3,767 |
$179K |
| 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 |
580 |
527 |
$173K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,714 |
2,700 |
$162K |
| A4927 |
Gloves, non-sterile, per 100 |
43,379 |
42,937 |
$159K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
158 |
142 |
$154K |
| L3808 |
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment |
701 |
351 |
$141K |
| L3702 |
Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
885 |
450 |
$133K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,230 |
2,213 |
$128K |
| 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 |
801 |
744 |
$125K |
| L3170 |
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each |
4,946 |
2,473 |
$119K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
1,422 |
733 |
$114K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
3,680 |
1,930 |
$105K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,173 |
1,123 |
$104K |
| L3320 |
Lift, elevation, heel and sole, cork, per inch |
2,150 |
1,093 |
$103K |
| L2300 |
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable |
511 |
500 |
$97K |
| E0601 |
Continuous positive airway pressure (cpap) device |
344 |
340 |
$97K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
922 |
471 |
$93K |
| L3400 |
Metatarsal bar wedge, rocker |
4,672 |
2,332 |
$90K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
492 |
492 |
$81K |
| E0575 |
Nebulizer, ultrasonic, large volume |
256 |
256 |
$76K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
214 |
190 |
$75K |
| L3310 |
Lift, elevation, heel and sole, neoprene, per inch |
1,530 |
767 |
$73K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,714 |
1,402 |
$73K |
| A7030 |
Full face mask used with positive airway pressure device, each |
875 |
872 |
$73K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
6,438 |
6,406 |
$72K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
160 |
160 |
$71K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,144 |
1,119 |
$70K |
| L3003 |
Foot, insert, removable, molded to patient model, silicone gel, each |
900 |
450 |
$69K |
| L2755 |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
1,510 |
755 |
$60K |
| L3420 |
Full sole and heel wedge, between sole |
2,160 |
1,080 |
$57K |
| L2114 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
219 |
218 |
$56K |
| L3340 |
Heel wedge, sach |
1,719 |
862 |
$54K |
| 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 |
1,236 |
618 |
$54K |
| L3050 |
Foot, arch support, removable, premolded, metatarsal, each |
1,855 |
928 |
$49K |
| L3760 |
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
284 |
142 |
$45K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
124 |
72 |
$40K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
437 |
430 |
$37K |
| L2768 |
Orthotic side bar disconnect device, per bar |
520 |
260 |
$33K |
| L3207 |
Orthopedic shoe, hightop with supinator or pronator, junior |
1,264 |
634 |
$30K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
1,062 |
1,061 |
$29K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
566 |
564 |
$26K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
529 |
528 |
$26K |
| L1850 |
Knee orthosis, swedish type, prefabricated, off-the-shelf |
131 |
110 |
$24K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
701 |
633 |
$23K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,209 |
1,197 |
$21K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,891 |
1,890 |
$21K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
603 |
586 |
$20K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
248 |
242 |
$20K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
160 |
160 |
$19K |
| L3360 |
Sole wedge, outside sole |
1,230 |
615 |
$19K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
600 |
302 |
$18K |
| L3762 |
Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf |
383 |
194 |
$18K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
122 |
122 |
$18K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
1,306 |
1,305 |
$17K |
| L3100 |
Hallus-valgus night dynamic splint, prefabricated, off-the-shelf |
586 |
294 |
$16K |
| A7035 |
Headgear used with positive airway pressure device |
1,605 |
1,602 |
$14K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
171 |
164 |
$13K |
| L1920 |
Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated |
86 |
43 |
$13K |
| L3430 |
Heel, counter, plastic reinforced |
4,245 |
2,122 |
$13K |
| A4670 |
Automatic blood pressure monitor |
278 |
278 |
$12K |
| L3916 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
52 |
38 |
$11K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,239 |
1,239 |
$11K |
| A7037 |
Tubing used with positive airway pressure device |
2,073 |
2,068 |
$11K |
| 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 |
467 |
235 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,227 |
1,204 |
$10K |
| L2116 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment |
36 |
36 |
$10K |
| 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 |
263 |
254 |
$10K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
209 |
208 |
$10K |
| K0001 |
Standard wheelchair |
364 |
360 |
$9K |
| L3332 |
Lift, elevation, inside shoe, tapered, up to one-half inch |
239 |
239 |
$9K |
| L1910 |
Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment |
84 |
42 |
$8K |
| L0170 |
Cervical, collar, molded to patient model |
37 |
37 |
$8K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
47 |
47 |
$7K |
| L1836 |
Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf |
64 |
64 |
$7K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
889 |
870 |
$6K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
54 |
52 |
$6K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
226 |
226 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
162 |
162 |
$5K |
| A7031 |
Face mask interface, replacement for full face mask, each |
408 |
408 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,321 |
2,314 |
$4K |
| L1831 |
Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment |
30 |
15 |
$4K |
| L0180 |
Cervical, multiple post collar, occipital/mandibular supports, adjustable |
29 |
28 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
496 |
483 |
$4K |
| L3960 |
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment |
12 |
12 |
$3K |
| E0656 |
Segmental pneumatic appliance for use with pneumatic compressor, trunk |
273 |
273 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
32 |
32 |
$3K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
64 |
63 |
$2K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
63 |
51 |
$2K |
| A4402 |
Lubricant, per ounce |
470 |
470 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
44 |
44 |
$1K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
92 |
92 |
$1K |
| E0242 |
Bath tub rail, floor base |
21 |
17 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
79 |
77 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
417 |
415 |
$1K |
| E0156 |
Seat attachment, walker |
80 |
80 |
$1K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
12 |
12 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,311 |
1,286 |
$925.70 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
660 |
659 |
$859.33 |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
17 |
16 |
$841.52 |
| A4614 |
Peak expiratory flow rate meter, hand held |
63 |
63 |
$827.60 |
| A4452 |
Tape, waterproof, per 18 square inches |
145 |
145 |
$774.98 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
85 |
62 |
$769.23 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
65 |
65 |
$762.94 |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
25 |
25 |
$670.00 |
| L3203 |
Orthopedic shoe, oxford with supinator or pronator, junior |
28 |
14 |
$656.60 |
| L3070 |
Foot, arch support, non-removable attached to shoe, longitudinal, each |
32 |
16 |
$601.28 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
28 |
26 |
$598.49 |
| E0215 |
Electric heat pad, moist |
45 |
45 |
$593.72 |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
27 |
26 |
$543.27 |
| A4565 |
Slings |
133 |
132 |
$523.48 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
17 |
17 |
$457.30 |
| E0241 |
Bath tub wall rail, each |
18 |
17 |
$437.24 |
| L2810 |
Addition to lower extremity orthosis, knee control, condylar pad |
20 |
12 |
$294.00 |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
13 |
13 |
$258.00 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
68 |
67 |
$208.76 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
168 |
166 |
$207.93 |
| L3450 |
Heel, sach cushion type |
50 |
25 |
$151.00 |
| L3380 |
Clubfoot wedge |
24 |
12 |
$140.76 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
12 |
12 |
$122.75 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
92 |
91 |
$121.93 |
| A4259 |
Lancets, per box of 100 |
25 |
25 |
$98.86 |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
12 |
12 |
$82.83 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
16 |
16 |
$43.24 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
92 |
91 |
$5.99 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
35 |
35 |
$1.62 |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
25 |
25 |
$0.00 |