| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
90,455 |
90,123 |
$7.35M |
| A4554 |
Disposable underpads, all sizes |
174,420 |
173,486 |
$7.17M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
51,509 |
51,283 |
$4.63M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
140,426 |
139,818 |
$4.35M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
73,399 |
73,097 |
$4.26M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
17,191 |
17,115 |
$2.98M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
56,192 |
55,648 |
$1.68M |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
13,987 |
13,750 |
$872K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
12,509 |
12,461 |
$673K |
| 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 |
8,364 |
8,287 |
$667K |
| A5120 |
Skin barrier, wipes or swabs, each |
32,083 |
30,373 |
$609K |
| 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 |
3,794 |
3,759 |
$496K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
17,810 |
17,445 |
$482K |
| A4927 |
Gloves, non-sterile, per 100 |
84,168 |
83,719 |
$374K |
| E0241 |
Bath tub wall rail, each |
13,938 |
13,893 |
$361K |
| 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 |
2,403 |
2,361 |
$235K |
| E1399 |
Durable medical equipment, miscellaneous |
2,675 |
2,474 |
$216K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
5,816 |
5,791 |
$189K |
| A4335 |
Incontinence supply; miscellaneous |
5,356 |
5,140 |
$143K |
| A4670 |
Automatic blood pressure monitor |
2,654 |
2,644 |
$120K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
4,587 |
4,500 |
$115K |
| A4402 |
Lubricant, per ounce |
16,840 |
15,327 |
$100K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
6,589 |
6,556 |
$96K |
| E0243 |
Toilet rail, each |
1,372 |
1,364 |
$82K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
851 |
851 |
$46K |
| K0001 |
Standard wheelchair |
1,640 |
1,634 |
$45K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
859 |
856 |
$43K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
788 |
786 |
$36K |
| E0244 |
Raised toilet seat |
1,758 |
1,751 |
$32K |
| A4259 |
Lancets, per box of 100 |
4,390 |
4,342 |
$27K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
464 |
459 |
$27K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
334 |
333 |
$27K |
| T4541 |
Incontinence product, disposable underpad, large, each |
557 |
554 |
$26K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
2,282 |
2,274 |
$25K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
121 |
118 |
$19K |
| K0003 |
Lightweight wheelchair |
503 |
501 |
$12K |
| E0156 |
Seat attachment, walker |
792 |
785 |
$11K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
143 |
142 |
$8K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
132 |
132 |
$8K |
| E0607 |
Home blood glucose monitor |
143 |
131 |
$7K |
| A4245 |
Alcohol wipes, per box |
4,310 |
4,274 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
547 |
515 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
252 |
251 |
$4K |
| B4100 |
Food thickener, administered orally, per ounce |
83 |
83 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
76 |
75 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,009 |
1,008 |
$2K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
15 |
13 |
$2K |
| E0246 |
Transfer tub rail attachment |
25 |
25 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
25 |
25 |
$968.85 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
14 |
13 |
$859.33 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
12 |
12 |
$845.22 |
| E0570 |
Nebulizer, with compressor |
27 |
27 |
$498.43 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
12 |
12 |
$497.60 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$349.71 |
| V5266 |
Battery for use in hearing device |
26 |
24 |
$334.06 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
36 |
36 |
$312.19 |