| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
2,470 |
2,372 |
$173K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,255 |
1,207 |
$167K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,185 |
2,071 |
$160K |
| K0003 |
Lightweight wheelchair |
5,883 |
5,847 |
$136K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
941 |
902 |
$110K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
3,260 |
3,203 |
$94K |
| K0005 |
Ultralightweight wheelchair |
157 |
151 |
$62K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
766 |
745 |
$57K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,217 |
2,198 |
$47K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
2,228 |
2,120 |
$37K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,017 |
1,006 |
$37K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,059 |
1,048 |
$32K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
228 |
218 |
$22K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
107 |
107 |
$18K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
602 |
572 |
$16K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
773 |
751 |
$13K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
616 |
606 |
$12K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
399 |
390 |
$11K |
| E0272 |
Mattress, foam rubber |
229 |
218 |
$9K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
182 |
171 |
$9K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
573 |
544 |
$9K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
144 |
136 |
$7K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
675 |
655 |
$7K |
| K0001 |
Standard wheelchair |
575 |
562 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
989 |
967 |
$6K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
572 |
543 |
$6K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
113 |
107 |
$4K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
363 |
316 |
$4K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
28 |
26 |
$4K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
503 |
498 |
$3K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
32 |
30 |
$3K |
| E0310 |
Bed side rails, full length |
51 |
51 |
$3K |
| 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 |
24 |
12 |
$2K |
| E0156 |
Seat attachment, walker |
295 |
292 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
222 |
222 |
$1K |
| 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 |
24 |
12 |
$1K |
| E0305 |
Bed side rails, half length |
411 |
404 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
13 |
12 |
$102.65 |