| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
22,336 |
22,308 |
$1.25M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
9,364 |
9,352 |
$940K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
7,764 |
7,750 |
$592K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,690 |
4,686 |
$546K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
11,108 |
11,085 |
$343K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
8,474 |
8,458 |
$272K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
677 |
676 |
$140K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
6,226 |
6,211 |
$111K |
| A4927 |
Gloves, non-sterile, per 100 |
18,593 |
18,583 |
$84K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
564 |
555 |
$75K |
| L1852 |
Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf |
544 |
354 |
$47K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,456 |
1,453 |
$40K |
| K0003 |
Lightweight wheelchair |
2,193 |
2,179 |
$38K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,209 |
1,198 |
$21K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
568 |
285 |
$21K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
197 |
195 |
$20K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
200 |
200 |
$13K |
| K0001 |
Standard wheelchair |
841 |
837 |
$11K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
220 |
216 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,201 |
3,181 |
$8K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
104 |
52 |
$8K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
143 |
72 |
$6K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
168 |
167 |
$6K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
480 |
329 |
$5K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
56 |
28 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
117 |
115 |
$4K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
20 |
12 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
170 |
167 |
$2K |
| E0849 |
Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible |
187 |
184 |
$2K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
24 |
12 |
$2K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
29 |
15 |
$1K |
| L1851 |
Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf |
23 |
19 |
$1K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
27 |
14 |
$1K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
50 |
50 |
$1K |
| E0156 |
Seat attachment, walker |
106 |
105 |
$860.10 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$425.92 |
| E0241 |
Bath tub wall rail, each |
12 |
12 |
$278.12 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$127.45 |