| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
52,843 |
51,913 |
$6.26M |
| 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 |
2,782 |
2,561 |
$4.35M |
| T4541 |
Incontinence product, disposable underpad, large, each |
54,469 |
53,080 |
$3.43M |
| E0601 |
Continuous positive airway pressure (cpap) device |
40,509 |
40,270 |
$2.84M |
| 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 |
1,076 |
1,026 |
$2.03M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
24,850 |
24,220 |
$1.99M |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
8,888 |
8,844 |
$1.62M |
| K0001 |
Standard wheelchair |
40,300 |
39,442 |
$1.47M |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
10,553 |
10,342 |
$1.44M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
15,488 |
15,173 |
$1.41M |
| A7030 |
Full face mask used with positive airway pressure device, each |
11,279 |
11,206 |
$1.28M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,666 |
2,546 |
$1.24M |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
2,608 |
2,589 |
$1.18M |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14,038 |
13,928 |
$1.18M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
17,127 |
16,753 |
$1.17M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,204 |
988 |
$1.12M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,135 |
4,036 |
$1.05M |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
18,844 |
18,672 |
$953K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
25,700 |
25,305 |
$928K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
9,555 |
9,366 |
$868K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
38,834 |
38,141 |
$823K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
6,621 |
6,455 |
$816K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
43,758 |
42,644 |
$710K |
| E0570 |
Nebulizer, with compressor |
8,447 |
8,181 |
$702K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12,825 |
12,591 |
$702K |
| A7035 |
Headgear used with positive airway pressure device |
24,300 |
24,149 |
$687K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,194 |
3,172 |
$684K |
| E0277 |
Powered pressure-reducing air mattress |
1,532 |
1,418 |
$644K |
| A4335 |
Incontinence supply; miscellaneous |
43,177 |
42,049 |
$637K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,763 |
1,730 |
$560K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
6,635 |
6,566 |
$550K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,926 |
2,868 |
$546K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,497 |
5,358 |
$543K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,216 |
4,128 |
$521K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,073 |
3,454 |
$511K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
574 |
373 |
$481K |
| K0007 |
Extra heavy duty wheelchair |
3,315 |
3,265 |
$456K |
| E1392 |
Portable oxygen concentrator, rental |
11,373 |
11,258 |
$418K |
| A4670 |
Automatic blood pressure monitor |
5,372 |
5,222 |
$411K |
| K0003 |
Lightweight wheelchair |
7,653 |
7,519 |
$376K |
| E0245 |
Tub stool or bench |
6,463 |
6,390 |
$354K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
5,709 |
5,670 |
$339K |
| A4927 |
Gloves, non-sterile, per 100 |
17,698 |
17,034 |
$338K |
| A7031 |
Face mask interface, replacement for full face mask, each |
6,601 |
6,547 |
$320K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
155 |
150 |
$292K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,901 |
1,860 |
$281K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
3,965 |
3,918 |
$234K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
663 |
649 |
$208K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,005 |
2,934 |
$205K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
12,340 |
11,724 |
$198K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
3,471 |
3,381 |
$190K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
149 |
149 |
$185K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,369 |
1,271 |
$182K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,040 |
388 |
$177K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
2,637 |
2,598 |
$174K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,362 |
1,342 |
$171K |
| A7037 |
Tubing used with positive airway pressure device |
6,314 |
6,275 |
$168K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
15,454 |
15,311 |
$162K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,984 |
1,893 |
$161K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,989 |
1,887 |
$158K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,794 |
1,723 |
$153K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,289 |
4,240 |
$148K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,923 |
1,643 |
$143K |
| E1399 |
Durable medical equipment, miscellaneous |
176 |
125 |
$138K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
553 |
540 |
$137K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
868 |
850 |
$128K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,794 |
2,728 |
$127K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,015 |
973 |
$118K |
| A7000 |
Canister, disposable, used with suction pump, each |
5,274 |
5,145 |
$117K |
| E0156 |
Seat attachment, walker |
8,414 |
8,256 |
$115K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,366 |
1,354 |
$113K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
4,393 |
4,312 |
$102K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
1,196 |
1,180 |
$99K |
| E0305 |
Bed side rails, half length |
7,550 |
7,451 |
$97K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
250 |
249 |
$96K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,737 |
1,685 |
$90K |
| E0271 |
Mattress, innerspring |
5,456 |
5,400 |
$87K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
893 |
875 |
$80K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
319 |
303 |
$80K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,928 |
1,872 |
$77K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
347 |
346 |
$74K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
1,868 |
1,839 |
$69K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
543 |
543 |
$64K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
227 |
216 |
$62K |
| T5999 |
Supply, not otherwise specified |
2,360 |
2,318 |
$62K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
380 |
372 |
$62K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
101 |
101 |
$59K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
5,158 |
4,774 |
$58K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,159 |
3,118 |
$58K |
| E0635 |
Patient lift, electric with seat or sling |
549 |
549 |
$54K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
302 |
299 |
$49K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,883 |
1,851 |
$49K |
| B9998 |
Noc for enteral supplies |
264 |
244 |
$48K |
| E0244 |
Raised toilet seat |
981 |
967 |
$45K |
| 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 |
583 |
583 |
$44K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
3,540 |
3,472 |
$43K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
446 |
430 |
$41K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
510 |
473 |
$40K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,013 |
964 |
$38K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
369 |
367 |
$37K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,872 |
2,803 |
$36K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
2,545 |
2,526 |
$36K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
518 |
507 |
$33K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
111 |
111 |
$32K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
160 |
159 |
$31K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
243 |
240 |
$31K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
453 |
435 |
$30K |
| A7002 |
Tubing, used with suction pump, each |
4,722 |
4,622 |
$29K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
886 |
877 |
$28K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,261 |
1,233 |
$26K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
39 |
39 |
$25K |
| A4623 |
Tracheostomy, inner cannula |
130 |
127 |
$25K |
| A4367 |
Ostomy belt, each |
1,559 |
1,537 |
$24K |
| E0297 |
Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress |
238 |
238 |
$24K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,419 |
1,413 |
$20K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
76 |
61 |
$20K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
129 |
129 |
$20K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
86 |
79 |
$19K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,050 |
1,965 |
$19K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
4,445 |
4,006 |
$19K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
85 |
85 |
$18K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
510 |
501 |
$17K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
507 |
506 |
$16K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
116 |
114 |
$16K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
243 |
239 |
$16K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
28 |
28 |
$16K |
| A4371 |
Ostomy skin barrier, powder, per oz |
2,293 |
2,265 |
$15K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,041 |
1,039 |
$13K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
12 |
12 |
$13K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
167 |
163 |
$12K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
25 |
25 |
$12K |
| A4332 |
Lubricant, individual sterile packet, each |
546 |
523 |
$11K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
103 |
101 |
$10K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
19 |
19 |
$9K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
12 |
12 |
$9K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
484 |
474 |
$9K |
| A7015 |
Aerosol mask, used with dme nebulizer |
4,221 |
4,106 |
$9K |
| A7525 |
Tracheostomy mask, each |
503 |
494 |
$8K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
114 |
91 |
$8K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
215 |
214 |
$8K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
410 |
409 |
$6K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
13 |
13 |
$4K |
| L8501 |
Tracheostomy speaking valve |
52 |
50 |
$4K |
| E0310 |
Bed side rails, full length |
178 |
175 |
$3K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
236 |
232 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
73 |
71 |
$3K |
| K0002 |
Standard hemi (low seat) wheelchair |
37 |
37 |
$2K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
12 |
12 |
$2K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
18 |
13 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
755 |
752 |
$2K |
| A7001 |
Canister, non-disposable, used with suction pump, each |
33 |
33 |
$2K |
| E0241 |
Bath tub wall rail, each |
65 |
63 |
$1K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
12 |
12 |
$1K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
64 |
64 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
51 |
50 |
$867.50 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
25 |
25 |
$820.92 |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
56 |
45 |
$759.73 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
12 |
12 |
$595.00 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
37 |
36 |
$574.20 |
| A4421 |
Ostomy supply; miscellaneous |
12 |
12 |
$289.67 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
13 |
13 |
$7.30 |
| S9999 |
Sales tax |
456 |
446 |
$0.00 |