| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
2,470 |
2,372 |
$173K |
| T4523 |
Adult size brief/diaper lg |
1,255 |
1,207 |
$167K |
| T4535 |
Disposable liner/shield/pad |
2,185 |
2,071 |
$160K |
| K0003 |
Lightweight wheelchair |
5,883 |
5,847 |
$136K |
| T4527 |
Adult size pull-on lg |
941 |
902 |
$110K |
| E0295 |
Hosp bed semi-elect w/o matt |
3,260 |
3,203 |
$94K |
| K0005 |
Ultralightweight wheelchair |
157 |
151 |
$62K |
| E2611 |
Gen use back cush wdth <22in |
766 |
745 |
$57K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,217 |
2,198 |
$47K |
| A6250 |
Skin seal protect moisturizr |
2,228 |
2,120 |
$37K |
| E0143 |
Walker folding wheeled w/o s |
1,017 |
1,006 |
$37K |
| E1390 |
Oxygen concentrator |
1,059 |
1,048 |
$32K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
228 |
218 |
$22K |
| T4524 |
Adult size brief/diaper xl |
107 |
107 |
$18K |
| E0971 |
Wheelchair anti-tipping devi |
602 |
572 |
$16K |
| E2601 |
Gen w/c cushion wdth < 22 in |
773 |
751 |
$13K |
| E0630 |
Patient lift hydraulic |
616 |
606 |
$12K |
| E0163 |
Commode chair with fixed arm |
399 |
390 |
$11K |
| E0272 |
Mattress foam rubber |
229 |
218 |
$9K |
| E0185 |
Gel pressure mattress pad |
182 |
171 |
$9K |
| E0961 |
Wheelchair brake extension |
573 |
544 |
$9K |
| E0990 |
Wheelchair elevating leg res |
144 |
136 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
675 |
655 |
$7K |
| K0001 |
Standard wheelchair |
575 |
562 |
$7K |
| E0431 |
Portable gaseous 02 |
989 |
967 |
$6K |
| E0951 |
Loop heel |
572 |
543 |
$6K |
| E0973 |
W/ch access det adj armrest |
113 |
107 |
$4K |
| T4536 |
Reusable pull-on any size |
363 |
316 |
$4K |
| T4522 |
Adult size brief/diaper med |
28 |
26 |
$4K |
| E1038 |
Transport chair pt wt<=300lb |
503 |
498 |
$3K |
| T4526 |
Adult size pull-on med |
32 |
30 |
$3K |
| E0310 |
Rails bed side full length |
51 |
51 |
$3K |
| A5512 |
Multi den insert direct form |
24 |
12 |
$2K |
| E0156 |
Walker seat attachment |
295 |
292 |
$1K |
| K0195 |
Elevating whlchair leg rests |
222 |
222 |
$1K |
| A5500 |
Diab shoe for density insert |
24 |
12 |
$1K |
| E0305 |
Rails bed side half length |
411 |
404 |
$1K |
| A4335 |
Incontinence supply |
13 |
12 |
$102.65 |