| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
13,046 |
12,036 |
$1.83M |
| T4541 |
Large disposable underpad |
37,572 |
34,888 |
$1.80M |
| T4528 |
Adult size pull-on xl |
11,059 |
10,327 |
$1.53M |
| T4535 |
Disposable liner/shield/pad |
19,861 |
18,313 |
$1.20M |
| T4543 |
Adult disp brief/diap abv xl |
4,967 |
4,614 |
$1.18M |
| A4927 |
Non-sterile gloves |
41,287 |
38,214 |
$1.11M |
| T4526 |
Adult size pull-on med |
7,305 |
6,781 |
$1.05M |
| A4520 |
Incontinence garment anytype |
5,365 |
4,501 |
$859K |
| T4524 |
Adult size brief/diaper xl |
5,007 |
4,615 |
$647K |
| A4553 |
Nondisp underpads, all sizes |
28,911 |
26,616 |
$431K |
| A6250 |
Skin seal protect moisturizr |
5,706 |
5,296 |
$292K |
| A4554 |
Disposable underpads |
3,907 |
3,320 |
$183K |
| T4523 |
Adult size brief/diaper lg |
1,372 |
1,288 |
$161K |
| A6530 |
Compression stocking bk18-30 |
756 |
647 |
$140K |
| T4525 |
Adult size pull-on sm |
929 |
869 |
$132K |
| T4522 |
Adult size brief/diaper med |
1,171 |
1,104 |
$98K |
| E1028 |
W/c manual swingaway |
801 |
454 |
$82K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,672 |
1,454 |
$61K |
| T4534 |
Youth size pull-on |
405 |
345 |
$58K |
| E0973 |
W/ch access det adj armrest |
721 |
545 |
$51K |
| T5999 |
Supply, nos |
432 |
350 |
$38K |
| K0001 |
Standard wheelchair |
1,126 |
1,007 |
$37K |
| T4537 |
Reusable underpad bed size |
2,419 |
2,162 |
$27K |
| E0971 |
Wheelchair anti-tipping devi |
471 |
349 |
$18K |
| E2611 |
Gen use back cush wdth <22in |
77 |
75 |
$11K |
| A5500 |
Diab shoe for density insert |
426 |
218 |
$9K |
| A5512 |
Multi den insert direct form |
210 |
112 |
$8K |
| E0955 |
Cushioned headrest |
90 |
77 |
$5K |
| E0951 |
Loop heel |
136 |
105 |
$4K |
| E2620 |
Wc planar back cush wd <22in |
15 |
13 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
112 |
105 |
$3K |
| K0195 |
Elevating whlchair leg rests |
212 |
209 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
53 |
51 |
$1K |