| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
13,125 |
12,783 |
$906K |
| T4523 |
Adult size brief/diaper lg |
5,369 |
5,263 |
$658K |
| T4524 |
Adult size brief/diaper xl |
3,367 |
3,285 |
$431K |
| T4522 |
Adult size brief/diaper med |
4,182 |
4,088 |
$404K |
| T4537 |
Reusable underpad bed size |
9,303 |
8,994 |
$266K |
| T4535 |
Disposable liner/shield/pad |
5,607 |
5,481 |
$197K |
| T4521 |
Adult size brief/diaper sm |
1,121 |
1,112 |
$106K |
| T4540 |
Reusable underpad chair size |
4,661 |
4,548 |
$68K |
| T4543 |
Adult disp brief/diap abv xl |
213 |
211 |
$63K |
| L3030 |
Foot arch support remov prem |
904 |
463 |
$55K |
| T4533 |
Youth size brief/diaper |
694 |
641 |
$52K |
| T4539 |
Reuse diaper/brief any size |
1,123 |
1,092 |
$30K |
| L3216 |
Orthoped ladies shoes dpth i |
534 |
275 |
$25K |
| K0001 |
Standard wheelchair |
1,534 |
1,530 |
$17K |
| A4927 |
Non-sterile gloves |
2,519 |
2,446 |
$11K |
| E0261 |
Hosp bed semi-electr w/o mat |
255 |
255 |
$8K |
| L3221 |
Orthopedic mens shoes dpth i |
140 |
70 |
$7K |
| L0648 |
Lso sag r an/pos pnl pre ots |
12 |
12 |
$7K |
| E0630 |
Patient lift hydraulic |
210 |
210 |
$6K |
| E0260 |
Hosp bed semi-electr w/ matt |
627 |
626 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
112 |
111 |
$3K |
| E0240 |
Bath/shower chair |
72 |
72 |
$2K |
| A5500 |
Diab shoe for density insert |
36 |
24 |
$2K |
| E0990 |
Wheelchair elevating leg res |
329 |
328 |
$1K |
| K0195 |
Elevating whlchair leg rests |
789 |
789 |
$1K |
| E0570 |
Nebulizer with compression |
24 |
24 |
$345.76 |
| E1038 |
Transport chair pt wt<=300lb |
222 |
222 |
$319.12 |
| K0003 |
Lightweight wheelchair |
13 |
13 |
$117.56 |