| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,746 |
5,434 |
$943K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
15,150 |
14,298 |
$896K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,426 |
5,179 |
$876K |
| T4541 |
Incontinence product, disposable underpad, large, each |
17,594 |
16,721 |
$850K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,613 |
2,461 |
$804K |
| A4927 |
Gloves, non-sterile, per 100 |
19,860 |
18,770 |
$566K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,207 |
3,035 |
$514K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,282 |
1,193 |
$182K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
985 |
924 |
$98K |
| K0001 |
Standard wheelchair |
8,232 |
7,872 |
$88K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
2,118 |
1,208 |
$81K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
472 |
452 |
$77K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
8,265 |
7,874 |
$58K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,875 |
1,082 |
$25K |
| A4553 |
Non-disposable underpads, all sizes |
1,608 |
1,564 |
$24K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
1,650 |
952 |
$17K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
957 |
895 |
$17K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,238 |
1,192 |
$17K |
| K0003 |
Lightweight wheelchair |
1,191 |
1,118 |
$16K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
620 |
589 |
$15K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
862 |
811 |
$14K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
642 |
600 |
$14K |
| K0006 |
Heavy duty wheelchair |
376 |
347 |
$14K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
217 |
209 |
$5K |
| K0002 |
Standard hemi (low seat) wheelchair |
870 |
852 |
$4K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
123 |
123 |
$252.49 |