| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
35,473 |
34,293 |
$1.99M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12,906 |
12,484 |
$1.50M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
14,720 |
14,289 |
$1.44M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
13,842 |
13,462 |
$1.19M |
| T4541 |
Incontinence product, disposable underpad, large, each |
26,822 |
25,681 |
$1.06M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,981 |
3,850 |
$661K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
2,516 |
2,428 |
$420K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,787 |
4,712 |
$414K |
| E1399 |
Durable medical equipment, miscellaneous |
1,020 |
994 |
$189K |
| 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 |
1,311 |
1,263 |
$179K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,502 |
2,452 |
$175K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
922 |
871 |
$134K |
| 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 |
699 |
672 |
$124K |
| A4927 |
Gloves, non-sterile, per 100 |
4,921 |
4,708 |
$101K |
| 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 |
421 |
406 |
$95K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
483 |
474 |
$94K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
841 |
840 |
$88K |
| A4335 |
Incontinence supply; miscellaneous |
2,035 |
1,873 |
$82K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
662 |
622 |
$78K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
559 |
534 |
$76K |
| S5165 |
Home modifications; per service |
491 |
491 |
$64K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
511 |
511 |
$62K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
918 |
918 |
$61K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,209 |
1,204 |
$43K |
| K0001 |
Standard wheelchair |
1,394 |
1,392 |
$35K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,109 |
1,082 |
$34K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
738 |
722 |
$26K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
696 |
693 |
$18K |
| E0241 |
Bath tub wall rail, each |
94 |
79 |
$12K |
| E0244 |
Raised toilet seat |
119 |
119 |
$11K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
352 |
352 |
$4K |
| 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 |
60 |
43 |
$3K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
24 |
24 |
$3K |
| E0246 |
Transfer tub rail attachment |
40 |
40 |
$3K |
| 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 |
60 |
43 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
40 |
40 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
546 |
545 |
$2K |
| K0003 |
Lightweight wheelchair |
27 |
27 |
$136.63 |