| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
7,749 |
5,727 |
$1.78M |
| A4554 |
Disposable underpads, all sizes |
25,555 |
24,332 |
$1.49M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,919 |
8,521 |
$1.00M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
8,656 |
8,063 |
$782K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,370 |
3,277 |
$399K |
| A4927 |
Gloves, non-sterile, per 100 |
24,881 |
23,650 |
$364K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
21,374 |
17,641 |
$298K |
| E0570 |
Nebulizer, with compressor |
4,547 |
4,454 |
$227K |
| E0246 |
Transfer tub rail attachment |
2,220 |
2,081 |
$204K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,070 |
2,017 |
$172K |
| A4670 |
Automatic blood pressure monitor |
4,406 |
4,179 |
$158K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,872 |
1,391 |
$147K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
2,543 |
1,943 |
$119K |
| E0245 |
Tub stool or bench |
1,959 |
1,823 |
$118K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
922 |
917 |
$100K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
9,797 |
9,669 |
$86K |
| K0001 |
Standard wheelchair |
3,413 |
3,329 |
$77K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
282 |
215 |
$71K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
756 |
586 |
$66K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,001 |
1,964 |
$65K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
667 |
639 |
$51K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
370 |
361 |
$49K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
311 |
246 |
$47K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, 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 padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
221 |
219 |
$35K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
983 |
966 |
$31K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
282 |
273 |
$27K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
445 |
434 |
$24K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
102 |
81 |
$23K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
276 |
266 |
$21K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
297 |
296 |
$18K |
| L3960 |
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment |
48 |
45 |
$17K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
79 |
63 |
$16K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
4,099 |
3,961 |
$14K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
273 |
189 |
$12K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
127 |
127 |
$11K |
| A7015 |
Aerosol mask, used with dme nebulizer |
9,789 |
9,667 |
$9K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
263 |
206 |
$9K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
39 |
39 |
$9K |
| K0002 |
Standard hemi (low seat) wheelchair |
176 |
168 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
752 |
707 |
$8K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
402 |
394 |
$7K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
260 |
235 |
$7K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
103 |
103 |
$6K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
716 |
706 |
$6K |
| E0156 |
Seat attachment, walker |
1,140 |
1,110 |
$6K |
| L0180 |
Cervical, multiple post collar, occipital/mandibular supports, adjustable |
35 |
35 |
$6K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
423 |
414 |
$5K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
590 |
579 |
$5K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
14 |
14 |
$5K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
608 |
594 |
$5K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
91 |
89 |
$4K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
58 |
51 |
$3K |
| 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 |
51 |
49 |
$3K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
70 |
54 |
$2K |
| 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 |
59 |
58 |
$2K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
13 |
12 |
$1K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
14 |
12 |
$1K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
117 |
117 |
$1K |
| L3762 |
Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf |
37 |
35 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
192 |
191 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
74 |
74 |
$1K |
| L0174 |
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf |
19 |
14 |
$1K |
| E0745 |
Neuromuscular stimulator, electronic shock unit |
22 |
12 |
$928.51 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
12 |
12 |
$416.29 |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
16 |
12 |
$411.06 |
| 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 |
19 |
13 |
$308.28 |
| 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 |
19 |
13 |
$285.10 |
| A4371 |
Ostomy skin barrier, powder, per oz |
37 |
37 |
$259.58 |
| A4402 |
Lubricant, per ounce |
36 |
36 |
$219.29 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
64 |
64 |
$203.31 |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
47 |
27 |
$200.44 |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
46 |
26 |
$86.57 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
12 |
12 |
$79.06 |