| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
5,072 |
4,996 |
$268K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,533 |
4,468 |
$252K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,461 |
1,392 |
$144K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,383 |
1,368 |
$105K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,823 |
1,799 |
$94K |
| K0001 |
Standard wheelchair |
1,477 |
1,475 |
$35K |
| E0245 |
Tub stool or bench |
601 |
601 |
$34K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,222 |
1,221 |
$27K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
646 |
638 |
$26K |
| K0003 |
Lightweight wheelchair |
709 |
705 |
$26K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
197 |
195 |
$18K |
| E0570 |
Nebulizer, with compressor |
1,276 |
1,273 |
$17K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
622 |
369 |
$15K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
222 |
221 |
$14K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,933 |
1,930 |
$9K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
106 |
105 |
$7K |
| E0156 |
Seat attachment, walker |
984 |
981 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
804 |
768 |
$6K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
322 |
321 |
$5K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
114 |
114 |
$5K |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
794 |
792 |
$3K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, 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 pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
180 |
180 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
53 |
53 |
$1K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
102 |
102 |
$1K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
26 |
26 |
$1K |
| A4259 |
Lancets, per box of 100 |
789 |
753 |
$871.72 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
24 |
24 |
$493.25 |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
27 |
15 |
$326.51 |
| E0310 |
Bed side rails, full length |
42 |
42 |
$104.02 |
| A4927 |
Gloves, non-sterile, per 100 |
14 |
13 |
$46.18 |
| A7015 |
Aerosol mask, used with dme nebulizer |
42 |
42 |
$20.60 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
14 |
14 |
$17.56 |