| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
15,468 |
14,523 |
$1.01M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,254 |
1,211 |
$209K |
| 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 |
1,608 |
1,567 |
$195K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
771 |
695 |
$192K |
| B9998 |
Noc for enteral supplies |
722 |
712 |
$103K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,387 |
1,092 |
$98K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
1,101 |
941 |
$95K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,553 |
1,434 |
$91K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
749 |
715 |
$70K |
| A4554 |
Disposable underpads, all sizes |
2,223 |
2,128 |
$67K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
788 |
770 |
$59K |
| A4670 |
Automatic blood pressure monitor |
2,287 |
2,196 |
$56K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
13,415 |
12,614 |
$55K |
| E1399 |
Durable medical equipment, miscellaneous |
79 |
74 |
$54K |
| K0001 |
Standard wheelchair |
1,974 |
1,892 |
$48K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
528 |
502 |
$45K |
| A7016 |
Dome and mouthpiece, used with small volume ultrasonic nebulizer |
13,385 |
12,588 |
$44K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
505 |
423 |
$41K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,136 |
1,092 |
$41K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
542 |
493 |
$40K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
969 |
948 |
$39K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,156 |
1,128 |
$34K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
410 |
359 |
$33K |
| A4927 |
Gloves, non-sterile, per 100 |
1,996 |
1,888 |
$28K |
| E0245 |
Tub stool or bench |
296 |
275 |
$16K |
| A7015 |
Aerosol mask, used with dme nebulizer |
13,362 |
12,475 |
$12K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,472 |
1,386 |
$12K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
953 |
902 |
$12K |
| A4616 |
Tubing (oxygen), per foot |
13,252 |
12,454 |
$11K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
236 |
236 |
$11K |
| A4402 |
Lubricant, per ounce |
741 |
729 |
$10K |
| 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 |
26 |
25 |
$9K |
| L3931 |
Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment |
100 |
89 |
$9K |
| E0156 |
Seat attachment, walker |
1,280 |
1,248 |
$8K |
| A4217 |
Sterile water/saline, 500 ml |
321 |
316 |
$7K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
436 |
426 |
$4K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
32 |
32 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
26 |
25 |
$2K |
| E0560 |
Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery |
30 |
30 |
$2K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
12 |
12 |
$2K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
12 |
12 |
$1K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
13 |
12 |
$1K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
13 |
13 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
111 |
109 |
$1K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
25 |
25 |
$603.03 |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
18 |
12 |
$192.24 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
29 |
24 |
$184.71 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
20 |
12 |
$160.08 |