| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
6,422 |
6,417 |
$709K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
23,608 |
23,424 |
$706K |
| A4554 |
Disposable underpads, all sizes |
18,832 |
18,640 |
$648K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
6,390 |
6,337 |
$469K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
7,361 |
7,212 |
$320K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,436 |
3,407 |
$271K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,077 |
4,013 |
$241K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
6,980 |
6,856 |
$198K |
| A4238 |
Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,340 |
2,288 |
$174K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
2,681 |
1,463 |
$171K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
3,554 |
3,490 |
$108K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
38 |
38 |
$79K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
472 |
458 |
$78K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,298 |
746 |
$60K |
| A4927 |
Gloves, non-sterile, per 100 |
9,231 |
9,058 |
$41K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
386 |
386 |
$41K |
| 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 |
772 |
516 |
$34K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
590 |
334 |
$32K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
235 |
235 |
$31K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
422 |
416 |
$19K |
| L8020 |
Breast prosthesis, mastectomy form |
172 |
141 |
$18K |
| 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 |
635 |
417 |
$16K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
129 |
105 |
$15K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
148 |
148 |
$14K |
| E0601 |
Continuous positive airway pressure (cpap) device |
601 |
594 |
$13K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
329 |
252 |
$10K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
153 |
151 |
$8K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
527 |
507 |
$7K |
| A4402 |
Lubricant, per ounce |
1,058 |
1,040 |
$6K |
| K0001 |
Standard wheelchair |
531 |
527 |
$4K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
216 |
215 |
$3K |
| E0570 |
Nebulizer, with compressor |
163 |
163 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
156 |
153 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
95 |
51 |
$2K |
| E1399 |
Durable medical equipment, miscellaneous |
245 |
245 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
52 |
52 |
$926.42 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
463 |
461 |
$838.76 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
37 |
37 |
$805.04 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
24 |
24 |
$494.78 |
| E2102 |
Adjunctive, non-implanted continuous glucose monitor or receiver |
12 |
12 |
$410.71 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
163 |
159 |
$281.60 |
| A7035 |
Headgear used with positive airway pressure device |
57 |
55 |
$273.59 |
| A7037 |
Tubing used with positive airway pressure device |
70 |
68 |
$258.98 |
| A4335 |
Incontinence supply; miscellaneous |
42 |
42 |
$218.40 |
| E0156 |
Seat attachment, walker |
43 |
43 |
$202.11 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
16 |
14 |
$136.94 |
| A7015 |
Aerosol mask, used with dme nebulizer |
15 |
15 |
$16.05 |