| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult size brief/diaper lg |
5,216 |
5,160 |
$416K |
| A4554 |
Disposable underpads |
9,875 |
9,757 |
$378K |
| T4524 |
Adult size brief/diaper xl |
3,517 |
3,477 |
$301K |
| T4522 |
Adult size brief/diaper med |
4,393 |
4,349 |
$278K |
| K0823 |
Pwc gp 2 std cap chair |
846 |
845 |
$146K |
| T4535 |
Disposable liner/shield/pad |
4,359 |
4,329 |
$118K |
| T4537 |
Reusable underpad bed size |
1,437 |
1,406 |
$45K |
| K0003 |
Lightweight wheelchair |
2,088 |
2,064 |
$41K |
| E1390 |
Oxygen concentrator |
645 |
645 |
$41K |
| A4670 |
Automatic bp monitor, dial |
532 |
514 |
$23K |
| T4543 |
Adult disp brief/diap abv xl |
159 |
159 |
$21K |
| E0240 |
Bath/shower chair |
651 |
641 |
$21K |
| E0143 |
Walker folding wheeled w/o s |
388 |
383 |
$15K |
| L3030 |
Foot arch support remov prem |
236 |
123 |
$14K |
| E0990 |
Wheelchair elevating leg res |
309 |
266 |
$14K |
| K0001 |
Standard wheelchair |
710 |
710 |
$13K |
| L3000 |
Ft insert ucb berkeley shell |
47 |
24 |
$12K |
| A5500 |
Diab shoe for density insert |
434 |
252 |
$11K |
| E0261 |
Hosp bed semi-electr w/o mat |
457 |
442 |
$10K |
| L3217 |
Ladies shoes hightop depth i |
115 |
61 |
$9K |
| E0431 |
Portable gaseous 02 |
597 |
597 |
$8K |
| A4927 |
Non-sterile gloves |
2,159 |
2,095 |
$8K |
| A5512 |
Multi den insert direct form |
422 |
244 |
$8K |
| T4539 |
Reuse diaper/brief any size |
226 |
222 |
$6K |
| E0601 |
Cont airway pressure device |
152 |
150 |
$6K |
| K0195 |
Elevating whlchair leg rests |
3,006 |
2,993 |
$5K |
| A4402 |
Lubricant per ounce |
1,158 |
1,126 |
$5K |
| A6530 |
Compression stocking bk18-30 |
206 |
122 |
$4K |
| E0156 |
Walker seat attachment |
350 |
345 |
$4K |
| T4521 |
Adult size brief/diaper sm |
54 |
54 |
$3K |
| L3020 |
Foot longitud/metatarsal sup |
30 |
13 |
$2K |
| E0244 |
Toilet seat raised |
71 |
71 |
$1K |
| E0973 |
W/ch access det adj armrest |
28 |
28 |
$953.63 |
| E0241 |
Bath tub wall rail |
32 |
32 |
$867.61 |
| E0562 |
Humidifier heated used w pap |
15 |
15 |
$819.14 |
| E2601 |
Gen w/c cushion wdth < 22 in |
50 |
50 |
$753.64 |
| A4660 |
Sphyg/bp app w cuff and stet |
24 |
24 |
$461.22 |
| E0971 |
Wheelchair anti-tipping devi |
13 |
12 |
$314.45 |
| E0978 |
W/c acc,saf belt pelv strap |
26 |
26 |
$229.83 |
| A7005 |
Nondisposable nebulizer set |
12 |
12 |
$196.20 |