| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
38,646 |
38,392 |
$1.94M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
18,388 |
18,264 |
$1.57M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
17,895 |
17,778 |
$1.12M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
9,762 |
9,685 |
$939K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
31,358 |
31,203 |
$792K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,440 |
2,430 |
$432K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
10,156 |
10,107 |
$290K |
| E1399 |
Durable medical equipment, miscellaneous |
7,221 |
7,090 |
$278K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
4,023 |
3,970 |
$236K |
| 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 |
2,893 |
2,853 |
$234K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
6,380 |
6,345 |
$232K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
3,643 |
3,578 |
$166K |
| 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 |
1,238 |
1,223 |
$154K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,003 |
1,983 |
$147K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,117 |
1,104 |
$135K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,396 |
1,379 |
$130K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,470 |
1,463 |
$111K |
| A4670 |
Automatic blood pressure monitor |
4,563 |
4,554 |
$90K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
2,786 |
2,779 |
$87K |
| A4927 |
Gloves, non-sterile, per 100 |
16,548 |
16,424 |
$72K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,941 |
1,935 |
$63K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,998 |
2,980 |
$63K |
| 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 |
786 |
773 |
$63K |
| E0277 |
Powered pressure-reducing air mattress |
462 |
458 |
$58K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
5,654 |
5,571 |
$54K |
| K0001 |
Standard wheelchair |
5,709 |
5,677 |
$53K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,910 |
3,883 |
$49K |
| E0241 |
Bath tub wall rail, each |
1,244 |
1,240 |
$49K |
| A4335 |
Incontinence supply; miscellaneous |
5,401 |
5,386 |
$48K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
993 |
981 |
$36K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,406 |
1,401 |
$32K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
2,012 |
2,009 |
$30K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
614 |
609 |
$24K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
307 |
306 |
$24K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
399 |
399 |
$24K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
516 |
512 |
$23K |
| E0570 |
Nebulizer, with compressor |
2,292 |
2,282 |
$20K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,386 |
2,356 |
$19K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
435 |
428 |
$17K |
| E0156 |
Seat attachment, walker |
2,939 |
2,907 |
$16K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
222 |
219 |
$14K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
146 |
146 |
$14K |
| A4259 |
Lancets, per box of 100 |
4,725 |
4,671 |
$13K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
246 |
245 |
$12K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
525 |
525 |
$11K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
85 |
85 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,682 |
5,640 |
$10K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
124 |
89 |
$9K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
338 |
330 |
$9K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
165 |
163 |
$8K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
609 |
608 |
$8K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
255 |
254 |
$7K |
| A4402 |
Lubricant, per ounce |
2,096 |
2,074 |
$7K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
246 |
176 |
$6K |
| A4452 |
Tape, waterproof, per 18 square inches |
819 |
811 |
$6K |
| A4217 |
Sterile water/saline, 500 ml |
1,354 |
1,342 |
$6K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
129 |
129 |
$5K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
94 |
94 |
$5K |
| E0244 |
Raised toilet seat |
277 |
275 |
$5K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
74 |
58 |
$5K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
246 |
241 |
$5K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
336 |
231 |
$5K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
414 |
410 |
$4K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
129 |
121 |
$4K |
| E0607 |
Home blood glucose monitor |
192 |
182 |
$4K |
| A4245 |
Alcohol wipes, per box |
3,092 |
3,076 |
$4K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
294 |
290 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
346 |
223 |
$3K |
| K0003 |
Lightweight wheelchair |
257 |
256 |
$3K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
41 |
41 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
400 |
397 |
$3K |
| K0006 |
Heavy duty wheelchair |
163 |
159 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
339 |
330 |
$2K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
292 |
290 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
232 |
231 |
$1K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
14 |
14 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
169 |
169 |
$997.06 |
| A4456 |
Adhesive remover, wipes, any type, each |
106 |
106 |
$928.24 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
55 |
55 |
$849.62 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
115 |
112 |
$784.43 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
181 |
178 |
$559.51 |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
12 |
12 |
$510.63 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
102 |
100 |
$497.13 |
| A7015 |
Aerosol mask, used with dme nebulizer |
518 |
515 |
$448.22 |
| A4371 |
Ostomy skin barrier, powder, per oz |
85 |
82 |
$368.46 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
97 |
97 |
$153.32 |