| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,484 |
3,051 |
$1.04M |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
7,966 |
7,349 |
$789K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,342 |
6,909 |
$322K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,941 |
1,843 |
$246K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,492 |
2,347 |
$215K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
299 |
241 |
$210K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,240 |
1,101 |
$182K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,328 |
1,216 |
$181K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,674 |
4,306 |
$175K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
3,218 |
2,918 |
$142K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,695 |
4,388 |
$140K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,403 |
4,133 |
$123K |
| E0570 |
Nebulizer, with compressor |
1,173 |
1,068 |
$84K |
| E1392 |
Portable oxygen concentrator, rental |
4,334 |
4,104 |
$83K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
554 |
514 |
$65K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,241 |
4,841 |
$60K |
| B9002 |
Enteral nutrition infusion pump, any type |
635 |
573 |
$58K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,428 |
1,338 |
$56K |
| A7035 |
Headgear used with positive airway pressure device |
3,551 |
3,343 |
$50K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,105 |
1,063 |
$47K |
| A4554 |
Disposable underpads, all sizes |
1,645 |
1,553 |
$43K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
152 |
95 |
$36K |
| T4541 |
Incontinence product, disposable underpad, large, each |
896 |
819 |
$33K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
404 |
376 |
$32K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
56 |
38 |
$31K |
| K0001 |
Standard wheelchair |
1,678 |
1,554 |
$26K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,573 |
7,085 |
$24K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
266 |
237 |
$22K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
784 |
729 |
$21K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
182 |
156 |
$18K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
158 |
146 |
$18K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,612 |
1,532 |
$16K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
568 |
510 |
$16K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
214 |
205 |
$14K |
| A4927 |
Gloves, non-sterile, per 100 |
642 |
541 |
$11K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
120 |
105 |
$10K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
266 |
259 |
$9K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
946 |
886 |
$9K |
| E0776 |
Iv pole |
929 |
827 |
$9K |
| L3260 |
Surgical boot/shoe, each |
587 |
547 |
$8K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
256 |
237 |
$7K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
135 |
130 |
$7K |
| A4565 |
Slings |
979 |
884 |
$7K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
28 |
27 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,381 |
1,295 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
200 |
154 |
$5K |
| A7001 |
Canister, non-disposable, used with suction pump, each |
231 |
220 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
621 |
552 |
$4K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
237 |
227 |
$4K |
| B9998 |
Noc for enteral supplies |
331 |
253 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
444 |
387 |
$4K |
| K0003 |
Lightweight wheelchair |
84 |
81 |
$4K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
615 |
551 |
$4K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
327 |
257 |
$3K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
35 |
32 |
$3K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
83 |
80 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
589 |
502 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
126 |
95 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
122 |
102 |
$2K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
13 |
12 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
266 |
224 |
$2K |
| 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 |
22 |
17 |
$2K |
| L2999 |
Lower extremity orthoses, not otherwise specified |
14 |
12 |
$2K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
35 |
28 |
$2K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
31 |
14 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
68 |
64 |
$2K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
15 |
14 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
32 |
28 |
$2K |
| A7526 |
Tracheostomy tube collar/holder, each |
46 |
36 |
$1K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
14 |
13 |
$1K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
56 |
51 |
$1K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
16 |
12 |
$1K |
| A4402 |
Lubricant, per ounce |
266 |
245 |
$1K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
14 |
13 |
$992.87 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
13 |
12 |
$956.38 |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
14 |
13 |
$881.95 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
74 |
62 |
$679.65 |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
15 |
12 |
$367.23 |
| A7037 |
Tubing used with positive airway pressure device |
44 |
42 |
$355.75 |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
12 |
12 |
$296.18 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
57 |
26 |
$176.40 |
| A4616 |
Tubing (oxygen), per foot |
116 |
83 |
$166.05 |
| E1399 |
Durable medical equipment, miscellaneous |
73 |
51 |
$114.87 |
| A4615 |
Cannula, nasal |
160 |
123 |
$103.63 |
| A4657 |
Syringe, with or without needle, each |
120 |
94 |
$99.13 |
| E0156 |
Seat attachment, walker |
14 |
13 |
$77.40 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
32 |
26 |
$43.91 |
| A4617 |
Mouth piece |
14 |
12 |
$43.44 |
| A7015 |
Aerosol mask, used with dme nebulizer |
14 |
12 |
$25.03 |
| A9270 |
Non-covered item or service |
15 |
12 |
$0.00 |