| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
24,695 |
23,046 |
$5.39M |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
943 |
853 |
$73K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,235 |
1,053 |
$54K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,288 |
1,107 |
$40K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
911 |
752 |
$38K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,112 |
1,834 |
$25K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,289 |
1,067 |
$22K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
1,003 |
589 |
$20K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
339 |
280 |
$18K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
346 |
288 |
$17K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,114 |
1,786 |
$10K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,703 |
1,473 |
$9K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
70 |
54 |
$6K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
45 |
38 |
$5K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
41 |
37 |
$3K |
| K0001 |
Standard wheelchair |
335 |
239 |
$3K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
75 |
63 |
$3K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
84 |
77 |
$3K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
35 |
26 |
$1K |
| E0601 |
Continuous positive airway pressure (cpap) device |
87 |
84 |
$1K |
| A4367 |
Ostomy belt, each |
132 |
106 |
$623.17 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
30 |
27 |
$117.88 |
| E0156 |
Seat attachment, walker |
16 |
12 |
$46.81 |
| A4371 |
Ostomy skin barrier, powder, per oz |
13 |
12 |
$29.88 |