| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
38,414 |
35,848 |
$22.33M |
| T4541 |
Incontinence product, disposable underpad, large, each |
65,294 |
63,750 |
$3.86M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
20,270 |
5,387 |
$2.64M |
| A4927 |
Gloves, non-sterile, per 100 |
53,832 |
51,045 |
$1.26M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14,561 |
14,328 |
$1.26M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
2,008 |
1,937 |
$1.10M |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,914 |
1,873 |
$930K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
3,887 |
3,645 |
$786K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
7,505 |
7,311 |
$682K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,916 |
11,903 |
$654K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,113 |
8,025 |
$611K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
5,081 |
4,846 |
$583K |
| E1399 |
Durable medical equipment, miscellaneous |
1,428 |
1,144 |
$563K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
9,672 |
9,010 |
$465K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
6,064 |
5,929 |
$451K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
7,557 |
7,460 |
$447K |
| K0001 |
Standard wheelchair |
5,628 |
5,302 |
$418K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
2,248 |
2,138 |
$379K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
3,013 |
2,558 |
$379K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,888 |
4,793 |
$373K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
3,501 |
3,125 |
$343K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,241 |
2,184 |
$304K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
4,619 |
4,474 |
$248K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
167 |
159 |
$225K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
12,096 |
10,711 |
$225K |
| T5999 |
Supply, not otherwise specified |
759 |
714 |
$216K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,694 |
2,335 |
$199K |
| A4402 |
Lubricant, per ounce |
31,138 |
29,700 |
$192K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,845 |
1,532 |
$192K |
| A5112 |
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each |
5,160 |
4,458 |
$174K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,150 |
1,077 |
$148K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,553 |
1,499 |
$146K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
10,409 |
6,205 |
$140K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
7,513 |
6,609 |
$111K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,357 |
2,309 |
$111K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
7,231 |
7,125 |
$103K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,988 |
1,858 |
$93K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,342 |
7,051 |
$87K |
| E0245 |
Tub stool or bench |
1,449 |
1,396 |
$80K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
714 |
681 |
$73K |
| A4335 |
Incontinence supply; miscellaneous |
7,525 |
7,376 |
$73K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,284 |
1,273 |
$70K |
| A4554 |
Disposable underpads, all sizes |
1,313 |
1,276 |
$62K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
2,742 |
2,550 |
$54K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
572 |
507 |
$53K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
639 |
628 |
$51K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,525 |
1,513 |
$50K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,107 |
2,090 |
$49K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
515 |
441 |
$45K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
298 |
241 |
$44K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,988 |
3,883 |
$44K |
| A5120 |
Skin barrier, wipes or swabs, each |
5,168 |
4,909 |
$43K |
| A4670 |
Automatic blood pressure monitor |
833 |
828 |
$42K |
| K0005 |
Ultralightweight wheelchair |
25 |
25 |
$42K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,344 |
2,205 |
$41K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
2,028 |
1,964 |
$38K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
141 |
138 |
$38K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
1,585 |
1,512 |
$34K |
| E0272 |
Mattress, foam rubber |
575 |
573 |
$33K |
| E0305 |
Bed side rails, half length |
1,083 |
1,031 |
$31K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
26 |
26 |
$28K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,082 |
1,937 |
$27K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
88 |
88 |
$25K |
| E0570 |
Nebulizer, with compressor |
676 |
665 |
$23K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,219 |
2,101 |
$21K |
| A7526 |
Tracheostomy tube collar/holder, each |
298 |
290 |
$20K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,212 |
1,070 |
$19K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
219 |
209 |
$19K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
112 |
110 |
$18K |
| E0156 |
Seat attachment, walker |
1,398 |
1,385 |
$17K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
1,665 |
1,587 |
$16K |
| K0040 |
Adjustable angle footplate, each |
139 |
110 |
$16K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
2,671 |
2,541 |
$16K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
102 |
48 |
$16K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
100 |
99 |
$14K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
174 |
170 |
$13K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
469 |
410 |
$13K |
| E0720 |
Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation |
82 |
82 |
$12K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
678 |
642 |
$12K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
214 |
205 |
$11K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
14 |
12 |
$10K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
62 |
60 |
$10K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
307 |
285 |
$9K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
273 |
235 |
$9K |
| A5114 |
Leg strap; foam or fabric, replacement only, per set |
772 |
719 |
$9K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
344 |
335 |
$9K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
64 |
62 |
$8K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
143 |
127 |
$8K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
74 |
64 |
$6K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
379 |
349 |
$5K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
262 |
254 |
$5K |
| A7000 |
Canister, disposable, used with suction pump, each |
462 |
450 |
$5K |
| E0310 |
Bed side rails, full length |
299 |
294 |
$4K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
126 |
92 |
$4K |
| E2624 |
Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
14 |
12 |
$3K |
| A4371 |
Ostomy skin barrier, powder, per oz |
343 |
331 |
$3K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
12 |
12 |
$3K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
14 |
13 |
$2K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
13 |
12 |
$2K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
70 |
68 |
$2K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
15 |
12 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
61 |
61 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
800 |
779 |
$1K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
25 |
25 |
$1K |
| A4322 |
Irrigation syringe, bulb or piston, each |
38 |
36 |
$924.23 |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
12 |
12 |
$921.78 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
35 |
30 |
$859.71 |
| E2212 |
Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each |
64 |
64 |
$722.60 |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
32 |
26 |
$640.29 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
46 |
44 |
$569.40 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
12 |
12 |
$387.04 |
| E0241 |
Bath tub wall rail, each |
14 |
14 |
$321.88 |
| K0019 |
Arm pad, replacement only, each |
13 |
13 |
$316.02 |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
14 |
13 |
$189.95 |