| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
5,751 |
2,196 |
$306K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,063 |
2,494 |
$127K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,555 |
1,582 |
$110K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,230 |
1,450 |
$84K |
| T4541 |
Incontinence product, disposable underpad, large, each |
13,722 |
8,690 |
$72K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,893 |
2,012 |
$67K |
| A4335 |
Incontinence supply; miscellaneous |
9,893 |
4,067 |
$61K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,501 |
692 |
$60K |
| A4927 |
Gloves, non-sterile, per 100 |
16,277 |
8,427 |
$57K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
458 |
192 |
$52K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
489 |
344 |
$27K |
| K0001 |
Standard wheelchair |
3,614 |
2,445 |
$26K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,902 |
1,377 |
$25K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,027 |
753 |
$24K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
945 |
641 |
$21K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,473 |
871 |
$18K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,203 |
896 |
$15K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,963 |
2,228 |
$13K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,218 |
2,509 |
$13K |
| A7002 |
Tubing, used with suction pump, each |
3,853 |
2,405 |
$12K |
| 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 |
340 |
227 |
$10K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
615 |
385 |
$9K |
| A4402 |
Lubricant, per ounce |
2,414 |
1,803 |
$8K |
| E0245 |
Tub stool or bench |
784 |
423 |
$7K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
309 |
217 |
$7K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
694 |
507 |
$7K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
126 |
61 |
$7K |
| A9270 |
Non-covered item or service |
2,100 |
1,622 |
$6K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
239 |
181 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,365 |
1,566 |
$4K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
130 |
72 |
$4K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
50 |
25 |
$4K |
| A7526 |
Tracheostomy tube collar/holder, each |
266 |
174 |
$3K |
| A4670 |
Automatic blood pressure monitor |
1,180 |
694 |
$3K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
167 |
119 |
$3K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,450 |
1,072 |
$3K |
| 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 |
102 |
38 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
119 |
78 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,469 |
1,118 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
160 |
91 |
$2K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
146 |
108 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
857 |
649 |
$2K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
270 |
228 |
$1K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
180 |
130 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
552 |
423 |
$1K |
| 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 |
83 |
25 |
$1K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
14 |
12 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
780 |
662 |
$988.64 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
73 |
39 |
$358.41 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
100 |
81 |
$281.56 |
| E0570 |
Nebulizer, with compressor |
146 |
87 |
$147.68 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
359 |
249 |
$109.22 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
192 |
151 |
$0.00 |
| K0007 |
Extra heavy duty wheelchair |
153 |
118 |
$0.00 |
| K0006 |
Heavy duty wheelchair |
120 |
82 |
$0.00 |
| K0003 |
Lightweight wheelchair |
96 |
75 |
$0.00 |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
12 |
12 |
$0.00 |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
106 |
62 |
$0.00 |