| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5165 |
Home modifications; per service |
537 |
517 |
$2.03M |
| A4554 |
Disposable underpads, all sizes |
24,530 |
24,184 |
$899K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,208 |
5,107 |
$800K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,029 |
5,956 |
$748K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
16,777 |
16,396 |
$711K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,078 |
5,002 |
$508K |
| 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 |
3,747 |
2,524 |
$292K |
| 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 |
1,525 |
1,036 |
$285K |
| E1399 |
Durable medical equipment, miscellaneous |
339 |
263 |
$200K |
| A4335 |
Incontinence supply; miscellaneous |
27,786 |
27,257 |
$151K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
846 |
829 |
$71K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
12,893 |
12,671 |
$64K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
298 |
288 |
$37K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
770 |
750 |
$37K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
264 |
241 |
$31K |
| K0003 |
Lightweight wheelchair |
1,876 |
1,836 |
$28K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
208 |
205 |
$22K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
124 |
121 |
$22K |
| A4670 |
Automatic blood pressure monitor |
115 |
111 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,009 |
976 |
$3K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
27 |
26 |
$518.91 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
12 |
$512.47 |
| E0570 |
Nebulizer, with compressor |
218 |
214 |
$225.85 |