| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
12,286 |
12,223 |
$863K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
5,278 |
5,241 |
$728K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,816 |
5,791 |
$618K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,103 |
3,092 |
$479K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,832 |
1,822 |
$150K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
582 |
582 |
$138K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
783 |
778 |
$79K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,420 |
1,414 |
$66K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,077 |
2,069 |
$64K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
587 |
587 |
$50K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
205 |
200 |
$41K |
| A5072 |
Ostomy pouch, urinary; without barrier attached (1 piece), each |
581 |
573 |
$41K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
289 |
288 |
$31K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
213 |
211 |
$25K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,382 |
1,378 |
$24K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
194 |
192 |
$23K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
259 |
258 |
$19K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
198 |
194 |
$15K |
| A4927 |
Gloves, non-sterile, per 100 |
2,483 |
2,466 |
$10K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
272 |
142 |
$8K |
| 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 |
53 |
53 |
$6K |
| A6205 |
Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
55 |
55 |
$4K |
| A4495 |
Surgical stockings thigh length, each |
73 |
66 |
$4K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
26 |
26 |
$4K |
| E0570 |
Nebulizer, with compressor |
87 |
87 |
$3K |
| L3485 |
Heel, pad, removable for spur |
160 |
160 |
$3K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
29 |
29 |
$3K |
| 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 |
58 |
58 |
$3K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
64 |
64 |
$2K |
| A4670 |
Automatic blood pressure monitor |
38 |
38 |
$1K |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
83 |
83 |
$1K |
| A4500 |
Surgical stockings below knee length, each |
34 |
27 |
$1K |
| E0241 |
Bath tub wall rail, each |
13 |
13 |
$559.80 |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
238 |
238 |
$505.43 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
16 |
16 |
$261.60 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
16 |
16 |
$221.92 |
| E0156 |
Seat attachment, walker |
12 |
12 |
$129.73 |
| L3230 |
Orthopedic footwear, custom shoe, depth inlay, each |
30 |
30 |
$73.29 |