| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
2,353 |
2,174 |
$50K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
860 |
856 |
$38K |
| K0003 |
Lightweight wheelchair |
721 |
636 |
$29K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,054 |
980 |
$23K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
648 |
579 |
$22K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
620 |
571 |
$16K |
| K0001 |
Standard wheelchair |
552 |
534 |
$12K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
12 |
12 |
$10K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
47 |
47 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
561 |
510 |
$5K |
| A4670 |
Automatic blood pressure monitor |
146 |
146 |
$4K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
135 |
117 |
$4K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
151 |
141 |
$4K |
| E0245 |
Tub stool or bench |
91 |
90 |
$3K |
| E0156 |
Seat attachment, walker |
272 |
272 |
$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 |
42 |
42 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
65 |
52 |
$2K |
| 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 |
27 |
27 |
$1K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
12 |
12 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
109 |
106 |
$576.24 |
| A4927 |
Gloves, non-sterile, per 100 |
217 |
193 |
$362.10 |
| A4335 |
Incontinence supply; miscellaneous |
301 |
274 |
$333.34 |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
13 |
13 |
$288.64 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
13 |
13 |
$145.50 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
41 |
39 |
$72.00 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
71 |
70 |
$67.20 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
29 |
28 |
$0.00 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
26 |
24 |
$0.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14 |
13 |
$0.00 |