| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,282 |
4,952 |
$506K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,118 |
3,820 |
$442K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,684 |
3,414 |
$402K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,250 |
3,121 |
$400K |
| 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 |
3,428 |
2,298 |
$345K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,771 |
2,620 |
$344K |
| A4554 |
Disposable underpads, all sizes |
6,722 |
6,139 |
$326K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,752 |
2,571 |
$301K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,271 |
4,892 |
$281K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,997 |
1,073 |
$250K |
| A4927 |
Gloves, non-sterile, per 100 |
11,323 |
9,651 |
$247K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,605 |
2,325 |
$154K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,176 |
874 |
$129K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
819 |
722 |
$88K |
| E0570 |
Nebulizer, with compressor |
1,441 |
1,339 |
$79K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
427 |
401 |
$36K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,429 |
2,835 |
$33K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
653 |
467 |
$31K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
373 |
293 |
$27K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
246 |
226 |
$23K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
641 |
535 |
$23K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
159 |
129 |
$23K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
665 |
592 |
$22K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
799 |
594 |
$21K |
| K0001 |
Standard wheelchair |
521 |
418 |
$20K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,730 |
1,450 |
$15K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
44 |
38 |
$15K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,030 |
831 |
$14K |
| A4553 |
Non-disposable underpads, all sizes |
863 |
815 |
$13K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
130 |
123 |
$12K |
| A4452 |
Tape, waterproof, per 18 square inches |
664 |
527 |
$11K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
158 |
111 |
$10K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
225 |
200 |
$8K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
283 |
232 |
$8K |
| B4100 |
Food thickener, administered orally, per ounce |
24 |
24 |
$8K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
111 |
100 |
$7K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
97 |
74 |
$5K |
| A4456 |
Adhesive remover, wipes, any type, each |
679 |
560 |
$5K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,003 |
846 |
$5K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
511 |
414 |
$4K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
256 |
185 |
$4K |
| E0245 |
Tub stool or bench |
75 |
67 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
480 |
394 |
$3K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
58 |
48 |
$3K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
26 |
24 |
$3K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
335 |
260 |
$3K |
| E0720 |
Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation |
69 |
58 |
$2K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
106 |
84 |
$2K |
| A4670 |
Automatic blood pressure monitor |
40 |
38 |
$2K |
| A6260 |
Wound cleansers, any type, any size |
126 |
93 |
$2K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
246 |
230 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
119 |
84 |
$1K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
65 |
53 |
$1K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
14 |
12 |
$741.80 |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
13 |
13 |
$604.42 |
| A4402 |
Lubricant, per ounce |
343 |
295 |
$388.38 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
51 |
49 |
$356.14 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
85 |
77 |
$168.44 |
| A7015 |
Aerosol mask, used with dme nebulizer |
108 |
107 |
$108.77 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
12 |
12 |
$4.67 |