| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5165 |
Home modifications; per service |
1,358 |
1,256 |
$5.71M |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,771 |
2,281 |
$713K |
| T4541 |
Incontinence product, disposable underpad, large, each |
4,172 |
3,962 |
$156K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,420 |
2,166 |
$148K |
| K0003 |
Lightweight wheelchair |
2,444 |
2,224 |
$145K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,211 |
1,106 |
$115K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
998 |
923 |
$90K |
| 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 |
784 |
728 |
$69K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,366 |
923 |
$68K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,483 |
1,410 |
$66K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
774 |
753 |
$65K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,794 |
1,672 |
$62K |
| A4927 |
Gloves, non-sterile, per 100 |
4,186 |
3,958 |
$59K |
| E0570 |
Nebulizer, with compressor |
1,315 |
1,204 |
$59K |
| K0001 |
Standard wheelchair |
1,537 |
1,406 |
$46K |
| A4670 |
Automatic blood pressure monitor |
1,069 |
1,031 |
$45K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
197 |
181 |
$41K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
476 |
407 |
$21K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,752 |
1,694 |
$16K |
| E0245 |
Tub stool or bench |
457 |
441 |
$14K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
805 |
375 |
$12K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
162 |
162 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
807 |
653 |
$11K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
323 |
304 |
$10K |
| E0156 |
Seat attachment, walker |
1,094 |
1,029 |
$10K |
| K0007 |
Extra heavy duty wheelchair |
96 |
76 |
$7K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
121 |
107 |
$6K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
300 |
242 |
$5K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
76 |
61 |
$4K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
82 |
75 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
129 |
126 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
18 |
12 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
14 |
12 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
19 |
15 |
$1K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
12 |
12 |
$1K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
33 |
26 |
$1K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12 |
12 |
$1K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
338 |
143 |
$999.36 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
15 |
12 |
$133.86 |