| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
30,062 |
28,617 |
$3.61M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
39,526 |
39,191 |
$3.50M |
| A4554 |
Disposable underpads, all sizes |
117,165 |
115,856 |
$2.85M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
23,530 |
23,275 |
$2.72M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
31,746 |
31,444 |
$2.23M |
| E1399 |
Durable medical equipment, miscellaneous |
24,257 |
10,988 |
$1.95M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
64,127 |
63,370 |
$1.80M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
7,135 |
7,071 |
$1.04M |
| T2028 |
Specialized supply, not otherwise specified, waiver |
11,885 |
11,850 |
$928K |
| A4335 |
Incontinence supply; miscellaneous |
158,482 |
155,765 |
$839K |
| 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 |
5,202 |
4,216 |
$486K |
| 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 |
1,382 |
1,104 |
$344K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,896 |
2,853 |
$339K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,249 |
4,179 |
$303K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,025 |
3,955 |
$288K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,005 |
2,989 |
$288K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
9,598 |
8,933 |
$263K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,152 |
992 |
$228K |
| A4670 |
Automatic blood pressure monitor |
3,789 |
3,708 |
$207K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,049 |
3,012 |
$180K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
981 |
911 |
$164K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,182 |
2,123 |
$148K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
1,724 |
1,724 |
$129K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,579 |
1,536 |
$120K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,135 |
1,098 |
$75K |
| B9998 |
Noc for enteral supplies |
569 |
415 |
$63K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,414 |
1,376 |
$59K |
| A4259 |
Lancets, per box of 100 |
7,013 |
6,785 |
$54K |
| S5199 |
Personal care item, nos, each |
727 |
539 |
$49K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
407 |
394 |
$41K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
466 |
454 |
$35K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
401 |
393 |
$24K |
| E0246 |
Transfer tub rail attachment |
386 |
374 |
$16K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
210 |
201 |
$13K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
114 |
111 |
$13K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
24 |
24 |
$12K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
152 |
135 |
$9K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
606 |
545 |
$9K |
| A4245 |
Alcohol wipes, per box |
6,387 |
6,287 |
$9K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,114 |
1,086 |
$7K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
257 |
244 |
$6K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
189 |
179 |
$6K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
676 |
610 |
$5K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
132 |
131 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
535 |
513 |
$5K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
292 |
265 |
$4K |
| A4456 |
Adhesive remover, wipes, any type, each |
399 |
378 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
347 |
333 |
$4K |
| E0570 |
Nebulizer, with compressor |
42 |
42 |
$4K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
504 |
473 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,565 |
1,536 |
$3K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
142 |
139 |
$3K |
| A4402 |
Lubricant, per ounce |
629 |
577 |
$3K |
| E0244 |
Raised toilet seat |
97 |
96 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
91 |
86 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
171 |
165 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
20 |
17 |
$958.37 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
56 |
54 |
$938.47 |
| E0602 |
Breast pump, manual, any type |
12 |
12 |
$376.80 |
| A4322 |
Irrigation syringe, bulb or piston, each |
12 |
12 |
$282.25 |
| A4371 |
Ostomy skin barrier, powder, per oz |
13 |
12 |
$43.19 |