| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
90,533 |
89,395 |
$3.23M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
27,301 |
27,033 |
$1.63M |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
47,379 |
46,872 |
$1.49M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12,601 |
12,374 |
$854K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12,936 |
12,765 |
$821K |
| T4541 |
Incontinence product, disposable underpad, large, each |
50,628 |
50,099 |
$756K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
8,844 |
8,734 |
$711K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,166 |
3,083 |
$598K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
36,775 |
36,385 |
$559K |
| A4553 |
Non-disposable underpads, all sizes |
14,397 |
14,330 |
$513K |
| A4554 |
Disposable underpads, all sizes |
16,778 |
16,686 |
$498K |
| A4927 |
Gloves, non-sterile, per 100 |
46,828 |
44,677 |
$485K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
6,913 |
6,679 |
$256K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,621 |
3,529 |
$254K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,581 |
3,539 |
$242K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
3,813 |
2,224 |
$216K |
| K0004 |
High strength, lightweight wheelchair |
4,067 |
3,918 |
$195K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
3,240 |
2,048 |
$138K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
3,162 |
2,985 |
$101K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,167 |
3,079 |
$98K |
| A4335 |
Incontinence supply; miscellaneous |
749 |
683 |
$96K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,368 |
1,343 |
$86K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
712 |
699 |
$71K |
| K0001 |
Standard wheelchair |
3,930 |
3,801 |
$54K |
| A4670 |
Automatic blood pressure monitor |
880 |
865 |
$46K |
| 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 |
2,580 |
1,608 |
$44K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,245 |
1,200 |
$40K |
| K0003 |
Lightweight wheelchair |
2,526 |
2,476 |
$37K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,378 |
1,329 |
$36K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
159 |
156 |
$35K |
| E0570 |
Nebulizer, with compressor |
2,967 |
2,896 |
$32K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
8,029 |
7,703 |
$30K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
422 |
406 |
$26K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,036 |
823 |
$24K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
474 |
468 |
$22K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
2,554 |
1,597 |
$19K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
259 |
254 |
$18K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
890 |
874 |
$16K |
| K0006 |
Heavy duty wheelchair |
425 |
395 |
$16K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
724 |
709 |
$16K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,568 |
2,505 |
$14K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
117 |
113 |
$14K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
299 |
260 |
$13K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
760 |
739 |
$11K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
93 |
81 |
$10K |
| W0137 |
|
15 |
14 |
$9K |
| 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 |
57 |
57 |
$9K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,004 |
814 |
$8K |
| E0277 |
Powered pressure-reducing air mattress |
24 |
24 |
$7K |
| 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 |
105 |
96 |
$6K |
| L0642 |
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, off-the-shelf |
38 |
38 |
$6K |
| E0156 |
Seat attachment, walker |
1,090 |
1,051 |
$5K |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
210 |
206 |
$5K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
574 |
458 |
$5K |
| A4928 |
Surgical mask, per 20 |
325 |
308 |
$5K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
262 |
245 |
$5K |
| E0144 |
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
53 |
52 |
$5K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
319 |
315 |
$4K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
514 |
498 |
$3K |
| 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 |
13 |
12 |
$2K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
12 |
12 |
$2K |
| E0627 |
Seat lift mechanism, electric, any type |
36 |
36 |
$1K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
15 |
13 |
$1K |
| A4259 |
Lancets, per box of 100 |
982 |
795 |
$832.38 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
16 |
15 |
$787.61 |
| K0007 |
Extra heavy duty wheelchair |
12 |
12 |
$744.42 |
| E0992 |
Manual wheelchair accessory, solid seat insert |
12 |
12 |
$391.10 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
251 |
251 |
$300.66 |