| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
112 |
94 |
$45K |
| 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 |
438 |
329 |
$40K |
| K0001 |
Standard wheelchair |
1,216 |
1,177 |
$28K |
| 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 |
232 |
169 |
$24K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
27 |
25 |
$20K |
| E0570 |
Nebulizer, with compressor |
312 |
302 |
$16K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
136 |
135 |
$16K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
851 |
234 |
$16K |
| A4670 |
Automatic blood pressure monitor |
102 |
100 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
178 |
176 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
26 |
26 |
$3K |
| T4541 |
Incontinence product, disposable underpad, large, each |
25 |
25 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
38 |
37 |
$2K |
| K0053 |
Elevating footrests, articulating (telescoping), each |
167 |
134 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12 |
12 |
$1K |
| 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 |
18 |
14 |
$845.85 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
148 |
140 |
$636.99 |
| E0141 |
Walker, rigid, wheeled, adjustable or fixed height |
12 |
12 |
$0.00 |