| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
408,516 |
403,635 |
$24.30M |
| A4554 |
Disposable underpads, all sizes |
1,277,478 |
1,262,375 |
$19.22M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
370,202 |
365,901 |
$18.32M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
248,908 |
245,878 |
$17.35M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
569,080 |
546,871 |
$10.03M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
100,535 |
99,420 |
$8.41M |
| A4335 |
Incontinence supply; miscellaneous |
1,907,676 |
1,886,204 |
$6.74M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
115,843 |
113,464 |
$3.88M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
96,394 |
95,147 |
$3.85M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
92,233 |
91,031 |
$3.31M |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
948,307 |
938,704 |
$3.28M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
54,151 |
53,471 |
$2.92M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
35,262 |
34,762 |
$2.47M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
57,113 |
56,419 |
$2.25M |
| 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 |
14,441 |
12,557 |
$1.86M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
9,699 |
9,221 |
$1.44M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
3,101 |
2,926 |
$1.42M |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
6,087 |
5,875 |
$1.28M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
25,443 |
24,825 |
$1.15M |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,914 |
3,338 |
$1.09M |
| E0240 |
Bath/shower chair, with or without wheels, any size |
11,228 |
10,501 |
$962K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
31,602 |
30,882 |
$962K |
| 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 |
4,233 |
3,850 |
$956K |
| A4670 |
Automatic blood pressure monitor |
9,327 |
9,272 |
$466K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
13,107 |
12,894 |
$419K |
| E1399 |
Durable medical equipment, miscellaneous |
10,316 |
9,394 |
$396K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
4,836 |
4,336 |
$395K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
839 |
818 |
$368K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,937 |
2,268 |
$363K |
| B4100 |
Food thickener, administered orally, per ounce |
3,627 |
3,514 |
$336K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
17,343 |
16,163 |
$327K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
442 |
421 |
$296K |
| B9998 |
Noc for enteral supplies |
4,750 |
4,420 |
$295K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,340 |
3,828 |
$276K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,524 |
1,490 |
$268K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
5,207 |
5,117 |
$261K |
| K0003 |
Lightweight wheelchair |
1,176 |
1,141 |
$186K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
2,657 |
2,446 |
$186K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
848 |
807 |
$150K |
| K0001 |
Standard wheelchair |
1,476 |
1,437 |
$141K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,593 |
1,542 |
$130K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,368 |
1,289 |
$130K |
| E0570 |
Nebulizer, with compressor |
1,952 |
1,886 |
$106K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
629 |
600 |
$94K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
529 |
491 |
$84K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,187 |
1,155 |
$79K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
994 |
968 |
$73K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,238 |
1,220 |
$71K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
2,029 |
1,955 |
$68K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
832 |
821 |
$67K |
| A4927 |
Gloves, non-sterile, per 100 |
65,934 |
64,563 |
$67K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
907 |
774 |
$64K |
| A4259 |
Lancets, per box of 100 |
13,153 |
12,594 |
$64K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
944 |
866 |
$60K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
7,287 |
6,829 |
$57K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
296 |
291 |
$57K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
619 |
590 |
$57K |
| E0246 |
Transfer tub rail attachment |
1,335 |
1,292 |
$54K |
| 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 |
65 |
62 |
$52K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,937 |
1,892 |
$50K |
| E0243 |
Toilet rail, each |
907 |
872 |
$50K |
| E0244 |
Raised toilet seat |
1,824 |
1,805 |
$50K |
| A4377 |
Ostomy pouch, drainable, for use on faceplate, plastic, each |
881 |
864 |
$49K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
634 |
612 |
$49K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,992 |
1,788 |
$46K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
2,013 |
1,967 |
$43K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
963 |
950 |
$41K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
3,726 |
3,510 |
$36K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,830 |
1,796 |
$34K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,976 |
1,823 |
$33K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
741 |
729 |
$33K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
4,493 |
4,174 |
$32K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
1,290 |
1,267 |
$32K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,842 |
5,448 |
$32K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,283 |
1,205 |
$31K |
| A4217 |
Sterile water/saline, 500 ml |
3,964 |
3,815 |
$30K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
267 |
265 |
$26K |
| 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 |
188 |
172 |
$26K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,513 |
2,426 |
$26K |
| A4402 |
Lubricant, per ounce |
7,320 |
7,180 |
$26K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,089 |
3,002 |
$24K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
259 |
251 |
$21K |
| A5120 |
Skin barrier, wipes or swabs, each |
4,020 |
3,662 |
$20K |
| A6260 |
Wound cleansers, any type, any size |
809 |
776 |
$19K |
| E0277 |
Powered pressure-reducing air mattress |
89 |
87 |
$19K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
149 |
148 |
$18K |
| K0007 |
Extra heavy duty wheelchair |
83 |
81 |
$16K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,438 |
2,292 |
$15K |
| K0006 |
Heavy duty wheelchair |
95 |
93 |
$14K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
4,598 |
4,445 |
$14K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
166 |
150 |
$13K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
786 |
754 |
$12K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,112 |
1,095 |
$12K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
282 |
275 |
$11K |
| E0245 |
Tub stool or bench |
359 |
348 |
$11K |
| A4245 |
Alcohol wipes, per box |
9,217 |
9,029 |
$11K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
87 |
84 |
$11K |
| 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 |
37 |
37 |
$8K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,664 |
2,516 |
$8K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
207 |
200 |
$7K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
147 |
145 |
$7K |
| A5112 |
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each |
194 |
182 |
$6K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
3,499 |
3,324 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,135 |
2,030 |
$4K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,387 |
1,350 |
$4K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
447 |
438 |
$4K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,099 |
1,059 |
$4K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
1,655 |
1,566 |
$3K |
| A4426 |
Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each |
72 |
65 |
$2K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
432 |
407 |
$2K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
12 |
12 |
$2K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
12 |
12 |
$2K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
26 |
25 |
$2K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
12 |
12 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,900 |
1,792 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
17 |
14 |
$1K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
54 |
54 |
$1K |
| A4258 |
Spring-powered device for lancet, each |
623 |
596 |
$1K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
85 |
80 |
$1K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14 |
14 |
$1K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,007 |
1,721 |
$1K |
| E0635 |
Patient lift, electric with seat or sling |
12 |
12 |
$1K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
35 |
29 |
$1K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
38 |
36 |
$830.73 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
191 |
190 |
$716.07 |
| B9002 |
Enteral nutrition infusion pump, any type |
12 |
12 |
$655.88 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
1,777 |
1,671 |
$606.01 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
42 |
37 |
$565.44 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
13 |
12 |
$348.25 |
| A4256 |
Normal, low and high calibrator solution / chips |
50 |
50 |
$221.00 |
| A4246 |
Betadine or phisohex solution, per pint |
50 |
50 |
$175.33 |
| E0325 |
Urinal; male, jug-type, any material |
12 |
12 |
$94.02 |
| E0156 |
Seat attachment, walker |
85 |
81 |
$13.21 |
| S9999 |
Sales tax |
30,835 |
30,206 |
$0.00 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
12 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
16 |
16 |
$0.00 |
| E0607 |
Home blood glucose monitor |
49 |
49 |
$0.00 |
| E0241 |
Bath tub wall rail, each |
15 |
14 |
$0.00 |