| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
32,730 |
31,568 |
$1.53M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
10,673 |
10,302 |
$1.52M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,658 |
8,375 |
$1.12M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,268 |
6,047 |
$906K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
6,927 |
6,702 |
$899K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
6,186 |
5,958 |
$829K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
11,672 |
11,220 |
$625K |
| A4927 |
Gloves, non-sterile, per 100 |
41,079 |
39,621 |
$621K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
2,719 |
2,636 |
$509K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,499 |
5,290 |
$498K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
974 |
950 |
$381K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
4,612 |
4,044 |
$184K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,605 |
1,356 |
$153K |
| A4553 |
Non-disposable underpads, all sizes |
10,272 |
9,936 |
$145K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
3,857 |
3,733 |
$140K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
791 |
751 |
$91K |
| K0004 |
High strength, lightweight wheelchair |
2,722 |
2,625 |
$84K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
486 |
435 |
$79K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
1,267 |
1,199 |
$71K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
1,232 |
1,197 |
$70K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
452 |
430 |
$63K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,011 |
726 |
$60K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,533 |
1,485 |
$58K |
| K0001 |
Standard wheelchair |
3,778 |
3,406 |
$58K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
6,730 |
6,439 |
$57K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,656 |
1,578 |
$53K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
989 |
921 |
$52K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
435 |
414 |
$49K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
178 |
174 |
$41K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
310 |
295 |
$39K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
763 |
724 |
$30K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
2,243 |
2,082 |
$26K |
| L3260 |
Surgical boot/shoe, each |
1,884 |
1,796 |
$25K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
370 |
353 |
$24K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
335 |
324 |
$21K |
| A4670 |
Automatic blood pressure monitor |
518 |
481 |
$19K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,047 |
1,800 |
$16K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
163 |
154 |
$15K |
| K0003 |
Lightweight wheelchair |
647 |
622 |
$15K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
487 |
462 |
$14K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
36 |
31 |
$13K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
659 |
629 |
$13K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
596 |
578 |
$12K |
| 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 |
38 |
26 |
$11K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
262 |
249 |
$9K |
| 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 |
60 |
59 |
$8K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
116 |
98 |
$6K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
31 |
26 |
$5K |
| A4554 |
Disposable underpads, all sizes |
121 |
119 |
$5K |
| E0570 |
Nebulizer, with compressor |
94 |
77 |
$3K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
57 |
54 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
217 |
201 |
$2K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
25 |
25 |
$2K |
| L2795 |
Addition to lower extremity orthosis, knee control, full kneecap |
15 |
15 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
67 |
60 |
$992.87 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
12 |
12 |
$683.54 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
147 |
143 |
$631.43 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
12 |
12 |
$623.88 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
48 |
40 |
$468.61 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
22 |
15 |
$217.66 |
| A4259 |
Lancets, per box of 100 |
13 |
13 |
$0.00 |