| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
47,671 |
47,188 |
$8.60M |
| T4541 |
Incontinence product, disposable underpad, large, each |
20,815 |
20,531 |
$1.16M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
16,094 |
15,421 |
$805K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,883 |
4,309 |
$715K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,904 |
7,817 |
$542K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
8,369 |
8,255 |
$486K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,259 |
4,188 |
$306K |
| K0001 |
Standard wheelchair |
4,170 |
4,021 |
$298K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,424 |
2,388 |
$240K |
| A4670 |
Automatic blood pressure monitor |
2,772 |
2,743 |
$174K |
| A4927 |
Gloves, non-sterile, per 100 |
7,156 |
6,918 |
$167K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
9,305 |
9,099 |
$141K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,855 |
4,283 |
$119K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,160 |
2,148 |
$117K |
| 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 |
2,169 |
1,569 |
$102K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
4,450 |
3,572 |
$101K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
1,296 |
1,286 |
$101K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,103 |
1,097 |
$95K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,191 |
1,174 |
$90K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
862 |
857 |
$84K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
74 |
73 |
$71K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,088 |
1,078 |
$58K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
5,439 |
5,362 |
$57K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
998 |
891 |
$55K |
| A4335 |
Incontinence supply; miscellaneous |
9,014 |
8,827 |
$47K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,282 |
1,247 |
$36K |
| E0601 |
Continuous positive airway pressure (cpap) device |
327 |
298 |
$32K |
| K0003 |
Lightweight wheelchair |
452 |
430 |
$31K |
| E0570 |
Nebulizer, with compressor |
329 |
324 |
$29K |
| E0245 |
Tub stool or bench |
460 |
456 |
$25K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
210 |
210 |
$22K |
| E0156 |
Seat attachment, walker |
1,611 |
1,603 |
$16K |
| 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 |
396 |
340 |
$16K |
| E0305 |
Bed side rails, half length |
1,151 |
1,117 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,829 |
1,038 |
$9K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
251 |
236 |
$9K |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
553 |
513 |
$6K |
| E0155 |
Wheel attachment, rigid pick-up walker, per pair |
491 |
479 |
$5K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
150 |
147 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
100 |
99 |
$2K |
| E0271 |
Mattress, innerspring |
93 |
93 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
48 |
48 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
34 |
29 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
70 |
70 |
$1K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
28 |
27 |
$1K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
57 |
27 |
$756.70 |
| E0970 |
No. 2 footplates, except for elevating leg rest |
15 |
15 |
$545.12 |
| A7035 |
Headgear used with positive airway pressure device |
12 |
12 |
$315.74 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
51 |
27 |
$255.97 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
29 |
28 |
$184.16 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
12 |
12 |
$178.94 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$168.96 |
| A4259 |
Lancets, per box of 100 |
70 |
70 |
$117.67 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
12 |
12 |
$107.97 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
27 |
26 |
$105.40 |
| A4258 |
Spring-powered device for lancet, each |
12 |
12 |
$12.58 |