| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult size brief/diaper lg |
529 |
508 |
$103K |
| T4535 |
Disposable liner/shield/pad |
504 |
492 |
$64K |
| T4541 |
Large disposable underpad |
518 |
508 |
$49K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
43 |
41 |
$27K |
| E0570 |
Nebulizer with compression |
192 |
192 |
$25K |
| E0601 |
Cont airway pressure device |
272 |
272 |
$18K |
| A4595 |
Tens suppl 2 lead per month |
235 |
225 |
$14K |
| L1844 |
Ko w/adj jt rot cntrl molded |
12 |
12 |
$11K |
| E0730 |
Tens four lead |
68 |
65 |
$7K |
| L2397 |
Suspension sleeve lower ext |
86 |
84 |
$4K |
| A7005 |
Nondisposable nebulizer set |
128 |
128 |
$3K |
| K0001 |
Standard wheelchair |
79 |
76 |
$3K |
| K0195 |
Elevating whlchair leg rests |
106 |
104 |
$1K |
| L2810 |
Knee control condylar pad |
24 |
24 |
$1K |
| E0154 |
Walker platform attachment |
15 |
15 |
$797.13 |
| L2830 |
Soft interface above knee se |
12 |
12 |
$631.69 |
| L2820 |
Soft interface below knee se |
12 |
12 |
$583.91 |
| K0003 |
Lightweight wheelchair |
12 |
12 |
$498.58 |
| E0143 |
Walker folding wheeled w/o s |
12 |
12 |
$422.56 |
| L2780 |
Non-corrosive finish |
12 |
12 |
$335.52 |
| A7015 |
Aerosol mask used w nebulize |
139 |
139 |
$228.44 |
| E0156 |
Walker seat attachment |
15 |
15 |
$147.80 |
| A7013 |
Disposable compressor filter |
60 |
60 |
$55.80 |