| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
4,790 |
4,547 |
$229K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,517 |
2,383 |
$169K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,275 |
1,211 |
$163K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,096 |
1,051 |
$146K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,037 |
998 |
$146K |
| A4927 |
Gloves, non-sterile, per 100 |
5,663 |
5,338 |
$132K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,356 |
1,716 |
$130K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
775 |
711 |
$89K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
347 |
318 |
$71K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
228 |
202 |
$61K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
2,775 |
2,602 |
$35K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
36 |
27 |
$34K |
| A4452 |
Tape, waterproof, per 18 square inches |
850 |
769 |
$33K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
4,446 |
4,161 |
$31K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
502 |
458 |
$30K |
| A4553 |
Non-disposable underpads, all sizes |
1,885 |
1,782 |
$27K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
657 |
602 |
$26K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,868 |
1,751 |
$24K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
121 |
106 |
$22K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,460 |
1,380 |
$21K |
| K0003 |
Lightweight wheelchair |
745 |
742 |
$19K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,319 |
1,205 |
$19K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
2,481 |
2,345 |
$13K |
| A4456 |
Adhesive remover, wipes, any type, each |
645 |
590 |
$12K |
| K0002 |
Standard hemi (low seat) wheelchair |
1,177 |
1,137 |
$12K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
76 |
75 |
$11K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
291 |
269 |
$8K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,086 |
994 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
271 |
244 |
$6K |
| K0001 |
Standard wheelchair |
1,642 |
1,525 |
$5K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
541 |
515 |
$5K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
38 |
38 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
224 |
213 |
$5K |
| E0570 |
Nebulizer, with compressor |
1,482 |
1,417 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
245 |
245 |
$4K |
| A4217 |
Sterile water/saline, 500 ml |
226 |
211 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
83 |
77 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
151 |
139 |
$3K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
14 |
13 |
$3K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
143 |
139 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
94 |
53 |
$3K |
| E0277 |
Powered pressure-reducing air mattress |
295 |
286 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$2K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
40 |
37 |
$1K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
25 |
24 |
$1K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12 |
12 |
$982.80 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
25 |
14 |
$804.66 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
43 |
40 |
$761.68 |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
12 |
12 |
$685.41 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
67 |
63 |
$614.74 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
57 |
52 |
$569.47 |
| A4371 |
Ostomy skin barrier, powder, per oz |
56 |
52 |
$569.31 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
13 |
13 |
$454.80 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
13 |
12 |
$384.20 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
24 |
24 |
$376.15 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
148 |
142 |
$374.93 |
| E0256 |
Hospital bed, variable height, hi-lo, with any type side rails, without mattress |
12 |
12 |
$149.08 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
24 |
24 |
$134.64 |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
191 |
190 |
$0.00 |