| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
2,570 |
2,550 |
$470K |
| T4527 |
Adult size pull-on lg |
2,605 |
2,569 |
$378K |
| A4554 |
Disposable underpads |
8,578 |
8,463 |
$295K |
| T4526 |
Adult size pull-on med |
1,841 |
1,827 |
$224K |
| E0570 |
Nebulizer with compression |
1,158 |
1,107 |
$77K |
| T4535 |
Disposable liner/shield/pad |
1,686 |
1,658 |
$52K |
| A4335 |
Incontinence supply |
8,516 |
8,429 |
$44K |
| K0003 |
Lightweight wheelchair |
2,187 |
2,167 |
$26K |
| E2228 |
Mwc acc, wheelchair brake |
1,252 |
1,226 |
$9K |
| K0195 |
Elevating whlchair leg rests |
2,863 |
2,807 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
135 |
131 |
$5K |
| K0001 |
Standard wheelchair |
412 |
403 |
$2K |
| A7003 |
Nebulizer administration set |
859 |
805 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
912 |
860 |
$841.49 |
| E0261 |
Hosp bed semi-electr w/o mat |
131 |
127 |
$372.94 |
| E2611 |
Gen use back cush wdth <22in |
13 |
13 |
$358.75 |
| E0316 |
Bed safety enclosure |
24 |
24 |
$356.28 |
| E0973 |
W/ch access det adj armrest |
13 |
13 |
$348.20 |
| E0143 |
Walker folding wheeled w/o s |
41 |
39 |
$263.88 |
| E2601 |
Gen w/c cushion wdth < 22 in |
13 |
13 |
$155.68 |
| A7013 |
Disposable compressor filter |
171 |
164 |
$112.86 |
| A7004 |
Disposable nebulizer sml vol |
24 |
24 |
$5.76 |
| E0156 |
Walker seat attachment |
41 |
39 |
$0.00 |