| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
714,650 |
671,149 |
$84.37M |
| T4534 |
Youth size pull-on |
545,082 |
503,271 |
$58.28M |
| T4535 |
Disposable liner/shield/pad |
779,210 |
723,775 |
$38.49M |
| T4532 |
Ped size pull-on lg |
343,529 |
315,701 |
$36.94M |
| A4554 |
Disposable underpads |
935,132 |
767,372 |
$36.12M |
| T4527 |
Adult size pull-on lg |
361,209 |
300,436 |
$33.31M |
| T4541 |
Large disposable underpad |
712,566 |
674,299 |
$29.67M |
| A4927 |
Non-sterile gloves |
1,391,623 |
1,220,345 |
$29.53M |
| T4526 |
Adult size pull-on med |
312,374 |
262,382 |
$27.16M |
| T4528 |
Adult size pull-on xl |
251,572 |
211,423 |
$25.09M |
| A6530 |
Compression stocking bk18-30 |
268,999 |
237,642 |
$18.43M |
| T4544 |
Adlt disp und/pull on abv xl |
116,593 |
95,258 |
$16.82M |
| L0621 |
Sio flex pelvic/sacr pre ots |
209,737 |
200,164 |
$11.50M |
| T4543 |
Adult disp brief/diap abv xl |
63,101 |
55,077 |
$10.42M |
| A4353 |
Intermittent urinary cath |
17,118 |
13,406 |
$9.62M |
| T4533 |
Youth size brief/diaper |
102,781 |
94,563 |
$9.41M |
| A4467 |
Belt strap sleev grmnt cover |
147,198 |
134,183 |
$8.36M |
| T4530 |
Ped size brief/diaper lg |
90,857 |
82,519 |
$7.43M |
| A4287 |
Disp col sto bag breast milk |
126,584 |
116,440 |
$6.83M |
| T4525 |
Adult size pull-on sm |
78,138 |
65,278 |
$6.28M |
| A4520 |
Incontinence garment anytype |
71,252 |
61,313 |
$6.21M |
| K1005 |
Disp col sto bag breast milk |
119,759 |
110,127 |
$5.80M |
| L2630 |
Pelvic control band & belt u |
37,121 |
34,784 |
$4.65M |
| A6212 |
Foam drg <=16 sq in w/border |
32,262 |
30,083 |
$3.93M |
| E0570 |
Nebulizer with compression |
91,516 |
52,846 |
$3.64M |
| T4523 |
Adult size brief/diaper lg |
36,398 |
28,125 |
$3.11M |
| T4522 |
Adult size brief/diaper med |
37,892 |
31,116 |
$3.00M |
| A4930 |
Sterile, gloves per pair |
22,402 |
15,337 |
$2.32M |
| T4524 |
Adult size brief/diaper xl |
24,566 |
19,232 |
$2.28M |
| A4351 |
Straight tip urine catheter |
23,454 |
17,082 |
$1.99M |
| T4531 |
Ped size pull-on sm/med |
18,114 |
16,394 |
$1.75M |
| A9900 |
Supply/accessory/service |
34,730 |
33,364 |
$1.54M |
| E0601 |
Cont airway pressure device |
63,414 |
40,693 |
$1.35M |
| T4521 |
Adult size brief/diaper sm |
14,560 |
12,701 |
$1.23M |
| B4150 |
Ef complet w/intact nutrient |
17,321 |
12,530 |
$1.23M |
| T4537 |
Reusable underpad bed size |
29,926 |
27,462 |
$1.21M |
| A7030 |
Cpap full face mask |
27,610 |
20,634 |
$1.19M |
| A7005 |
Nondisposable nebulizer set |
61,876 |
51,711 |
$1.18M |
| A4627 |
Spacer bag/reservoir |
36,060 |
30,650 |
$1.16M |
| A4352 |
Coude tip urinary catheter |
4,034 |
3,096 |
$1.13M |
| E1390 |
Oxygen concentrator |
49,689 |
17,451 |
$1.11M |
| L0641 |
Lo rig pos pnl l1-l5 pre ots |
21,930 |
21,254 |
$1.07M |
| E0202 |
Phototherapy light w/ photom |
26,035 |
2,344 |
$946K |
| B4154 |
Ef spec metabolic noninherit |
9,916 |
7,327 |
$919K |
| A4335 |
Incontinence supply |
144,080 |
107,618 |
$873K |
| T5999 |
Supply, nos |
65,071 |
64,278 |
$828K |
| A6250 |
Skin seal protect moisturizr |
28,201 |
23,241 |
$824K |
| A7031 |
Replacement facemask interfa |
31,412 |
23,106 |
$782K |
| S5199 |
Personal care item nos each |
80,338 |
79,053 |
$739K |
| E0562 |
Humidifier heated used w pap |
10,870 |
8,471 |
$735K |
| A6245 |
Hydrogel drg <= 16 in w/bdr |
26,878 |
25,661 |
$719K |
| A4239 |
Non-adju cgm supply allow |
14,465 |
10,879 |
$586K |
| A7034 |
Nasal application device |
21,706 |
16,360 |
$579K |
| A7032 |
Replacement nasal cushion |
16,038 |
12,045 |
$421K |
| A7035 |
Pos airway press headgear |
32,179 |
25,107 |
$334K |
| A4604 |
Tubing with heating element |
23,994 |
18,283 |
$328K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
2,210 |
2,098 |
$299K |
| T1999 |
Noc retail items andsupplies |
9,941 |
8,024 |
$298K |
| E0470 |
Rad w/o backup non-inv intfc |
7,964 |
4,670 |
$287K |
| A7037 |
Pos airway pressure tubing |
24,989 |
18,484 |
$221K |
| A7038 |
Pos airway pressure filter |
60,193 |
44,418 |
$192K |
| E0445 |
Oximeter non-invasive |
1,821 |
1,145 |
$190K |
| A4282 |
Replacement breastpump adpt |
14,398 |
12,594 |
$174K |
| A7033 |
Replacement nasal pillows |
8,871 |
6,156 |
$173K |
| A4349 |
Disposable male external cat |
6,026 |
4,582 |
$169K |
| A4284 |
Replcmnt breast pump shield |
14,570 |
12,798 |
$162K |
| A4344 |
Cath indw foley 2 way silicn |
4,959 |
3,638 |
$158K |
| E0466 |
Home vent non-invasive inter |
1,634 |
427 |
$158K |
| A4281 |
Replacement breastpump tube |
14,393 |
12,599 |
$156K |
| A4357 |
Bedside drainage bag |
19,861 |
14,828 |
$146K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,160 |
922 |
$142K |
| E0471 |
Rad w/backup non inv intrfc |
1,168 |
777 |
$132K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,858 |
1,431 |
$126K |
| A9276 |
Disposable sensor, cgm sys |
1,570 |
1,190 |
$125K |
| A6197 |
Alginate drsg >16 <=48 sq in |
646 |
567 |
$118K |
| E0260 |
Hosp bed semi-electr w/ matt |
6,224 |
2,813 |
$115K |
| T4529 |
Ped size brief/diaper sm/med |
1,540 |
1,402 |
$111K |
| S9999 |
Sales tax |
12,361 |
12,351 |
$109K |
| A7015 |
Aerosol mask used w nebulize |
51,579 |
43,631 |
$103K |
| A7046 |
Repl water chamber, pap dev |
21,042 |
17,349 |
$99K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,737 |
1,238 |
$98K |
| A4385 |
Ost skn barrier sld ext wear |
1,745 |
1,462 |
$93K |
| E0431 |
Portable gaseous 02 |
27,934 |
8,727 |
$92K |
| K0553 |
Ther cgm supply allowance |
4,062 |
2,583 |
$92K |
| A4217 |
Sterile water/saline, 500 ml |
5,297 |
3,493 |
$87K |
| A4617 |
Mouth piece |
27,359 |
24,489 |
$81K |
| A4358 |
Urinary leg or abdomen bag |
14,747 |
11,373 |
$78K |
| A4283 |
Replacement breastpump cap |
14,216 |
12,652 |
$67K |
| A4285 |
Replcmnt breast pump bottle |
14,053 |
12,635 |
$62K |
| A7045 |
Repl exhalation port for pap |
13,573 |
10,768 |
$58K |
| A4213 |
20+ cc syringe only |
3,216 |
2,703 |
$56K |
| A4310 |
Insert tray w/o bag/cath |
8,409 |
6,330 |
$56K |
| E0619 |
Apnea monitor w recorder |
447 |
334 |
$55K |
| K0001 |
Standard wheelchair |
6,125 |
2,775 |
$54K |
| E0630 |
Patient lift hydraulic |
1,235 |
595 |
$50K |
| A4553 |
Nondisp underpads, all sizes |
3,683 |
3,121 |
$40K |
| A7039 |
Filter, non disposable w pap |
10,479 |
7,697 |
$40K |
| A7013 |
Disposable compressor filter |
66,007 |
55,012 |
$39K |
| A4362 |
Solid skin barrier |
1,177 |
877 |
$38K |
| A4394 |
Ostomy pouch liq deodorant |
2,763 |
2,073 |
$37K |
| E2103 |
Non-adju cgm receiver/mon |
876 |
729 |
$35K |
| A4286 |
Replcmnt breastpump lok ring |
14,229 |
12,550 |
$35K |
| E0277 |
Powered pres-redu air mattrs |
784 |
349 |
$35K |
| K0823 |
Pwc gp 2 std cap chair |
1,378 |
302 |
$33K |
| A4338 |
Indwelling catheter latex |
5,546 |
4,143 |
$32K |
| A4456 |
Adhesive remover, wipes |
6,303 |
4,625 |
$32K |
| A4425 |
Ost pch drain for barrier fl |
970 |
717 |
$30K |
| A4400 |
Ostomy irrigation set |
546 |
459 |
$28K |
| E2402 |
Neg press wound therapy pump |
742 |
596 |
$28K |
| A4406 |
Pectin based ostomy paste |
2,709 |
2,201 |
$26K |
| A5063 |
Drain ostomy pouch w/flange |
1,115 |
823 |
$25K |
| A4332 |
Lube sterile packet |
5,597 |
4,611 |
$25K |
| A4407 |
Ext wear ost skn barr <=4sq" |
313 |
261 |
$24K |
| A4322 |
Irrigation syringe |
3,441 |
2,605 |
$23K |
| A5120 |
Skin barrier, wipe or swab |
5,249 |
3,697 |
$23K |
| E0443 |
Portable 02 contents, gas |
5,388 |
1,543 |
$19K |
| K0738 |
Portable gas oxygen system |
4,119 |
1,096 |
$18K |
| E0143 |
Walker folding wheeled w/o s |
1,196 |
837 |
$16K |
| A4371 |
Skin barrier powder per oz |
2,877 |
2,254 |
$16K |
| A4402 |
Lubricant per ounce |
4,932 |
3,768 |
$15K |
| A4331 |
Extension drainage tubing |
5,628 |
4,623 |
$15K |
| A6550 |
Neg pres wound ther drsg set |
498 |
362 |
$15K |
| A4452 |
Waterproof tape |
1,718 |
1,299 |
$14K |
| E0163 |
Commode chair with fixed arm |
906 |
550 |
$14K |
| E0602 |
Manual breast pump |
2,345 |
2,010 |
$14K |
| A4340 |
Indwelling catheter special |
840 |
583 |
$13K |
| 94660 |
|
453 |
361 |
$13K |
| K0195 |
Elevating whlchair leg rests |
3,624 |
2,119 |
$12K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
227 |
190 |
$10K |
| K0003 |
Lightweight wheelchair |
701 |
416 |
$8K |
| K0554 |
Ther cgm receiver/monitor |
346 |
235 |
$8K |
| B4036 |
Enteral feed sup kit grav by |
1,010 |
822 |
$8K |
| K0004 |
High strength ltwt whlchr |
389 |
325 |
$7K |
| 94799 |
|
354 |
303 |
$6K |
| A7000 |
Disposable canister for pump |
615 |
429 |
$5K |
| E1392 |
Portable oxygen concentrator |
1,634 |
528 |
$5K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,161 |
1,210 |
$5K |
| A7036 |
Pos airway press chinstrap |
986 |
765 |
$4K |
| A4614 |
Hand-held pefr meter |
203 |
189 |
$4K |
| A4333 |
Urinary cath anchor device |
2,849 |
2,282 |
$4K |
| A4334 |
Urinary cath leg strap |
1,224 |
852 |
$3K |
| A4450 |
Non-waterproof tape |
1,043 |
784 |
$3K |
| A4367 |
Ostomy belt |
820 |
684 |
$2K |
| A4432 |
Os pch urine w bar/fange/tap |
40 |
37 |
$2K |
| E0149 |
Heavy duty wheeled walker |
821 |
370 |
$2K |
| K0006 |
Heavy duty wheelchair |
203 |
73 |
$2K |
| A9278 |
External receiver, cgm sys |
13 |
12 |
$1K |
| E2601 |
Gen w/c cushion wdth < 22 in |
333 |
123 |
$1K |
| E0971 |
Wheelchair anti-tipping devi |
115 |
108 |
$1K |
| E2611 |
Gen use back cush wdth <22in |
27 |
25 |
$974.48 |
| E0627 |
Seat lift mech, electric any |
14 |
14 |
$971.74 |
| E0303 |
Hosp bed hvy dty xtra wide |
22 |
13 |
$925.09 |
| E0156 |
Walker seat attachment |
238 |
182 |
$792.23 |
| E0165 |
Commode chair with detacharm |
148 |
77 |
$612.79 |
| E1028 |
W/c manual swingaway |
334 |
78 |
$461.14 |
| 99503 |
|
119 |
93 |
$386.00 |
| E1399 |
Durable medical equipment mi |
65 |
51 |
$313.45 |
| A4320 |
Irrigation tray |
177 |
114 |
$250.40 |
| E1353 |
Oxygen supplies regulator |
272 |
227 |
$248.32 |
| E0910 |
Trapeze bar attached to bed |
22 |
12 |
$215.42 |
| E0978 |
W/c acc,saf belt pelv strap |
28 |
27 |
$158.71 |
| E1355 |
Oxygen supplies stand/rack |
946 |
571 |
$124.58 |
| E0261 |
Hosp bed semi-electr w/o mat |
12 |
12 |
$96.41 |
| E0181 |
Press pad alternating w/ pum |
41 |
36 |
$67.00 |
| A6402 |
Sterile gauze <= 16 sq in |
14 |
13 |
$45.51 |
| A4615 |
Cannula nasal |
18 |
12 |
$11.65 |
| A9999 |
Dme supply or accessory, nos |
16 |
13 |
$0.01 |
| BILIMIS |
|
44 |
41 |
$0.00 |
| 99199 |
|
1,125 |
480 |
$0.00 |