| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
14,870 |
14,794 |
$882K |
| T4527 |
Adult size pull-on lg |
4,020 |
4,007 |
$294K |
| T4535 |
Disposable liner/shield/pad |
6,623 |
6,580 |
$291K |
| E0295 |
Hosp bed semi-elect w/o matt |
10,314 |
10,206 |
$284K |
| T4526 |
Adult size pull-on med |
4,475 |
4,455 |
$273K |
| E1390 |
Oxygen concentrator |
6,955 |
6,842 |
$213K |
| T4528 |
Adult size pull-on xl |
1,976 |
1,965 |
$152K |
| T4523 |
Adult size brief/diaper lg |
1,562 |
1,552 |
$151K |
| K0001 |
Standard wheelchair |
10,077 |
9,960 |
$121K |
| K0003 |
Lightweight wheelchair |
4,963 |
4,912 |
$86K |
| T4537 |
Reusable underpad bed size |
2,975 |
2,948 |
$86K |
| A6250 |
Skin seal protect moisturizr |
5,314 |
5,278 |
$83K |
| E0630 |
Patient lift hydraulic |
3,833 |
3,811 |
$83K |
| E2611 |
Gen use back cush wdth <22in |
1,386 |
1,365 |
$70K |
| E0185 |
Gel pressure mattress pad |
1,067 |
1,049 |
$68K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,924 |
2,883 |
$54K |
| E0272 |
Mattress foam rubber |
1,071 |
1,063 |
$53K |
| E1031 |
Rollabout chair with casters |
3,485 |
3,454 |
$48K |
| E0310 |
Rails bed side full length |
1,162 |
1,154 |
$47K |
| T4524 |
Adult size brief/diaper xl |
484 |
483 |
$41K |
| T4525 |
Adult size pull-on sm |
656 |
654 |
$39K |
| E0431 |
Portable gaseous 02 |
5,952 |
5,831 |
$35K |
| E0245 |
Tub stool or bench |
629 |
624 |
$35K |
| A4335 |
Incontinence supply |
4,590 |
4,576 |
$33K |
| E0143 |
Walker folding wheeled w/o s |
1,387 |
1,353 |
$32K |
| E2601 |
Gen w/c cushion wdth < 22 in |
831 |
819 |
$15K |
| E0277 |
Powered pres-redu air mattrs |
734 |
725 |
$13K |
| K0195 |
Elevating whlchair leg rests |
2,526 |
2,506 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
1,006 |
987 |
$10K |
| E0570 |
Nebulizer with compression |
4,454 |
4,388 |
$9K |
| E0978 |
W/c acc,saf belt pelv strap |
1,169 |
1,151 |
$9K |
| K0739 |
Repair/svc dme non-oxygen eq |
287 |
274 |
$9K |
| E0600 |
Suction pump portab hom modl |
389 |
380 |
$5K |
| E1226 |
Manual fully reclining back |
293 |
287 |
$4K |
| A4927 |
Non-sterile gloves |
555 |
555 |
$3K |
| E0961 |
Wheelchair brake extension |
426 |
420 |
$3K |
| E0951 |
Loop heel |
334 |
329 |
$3K |
| K0823 |
Pwc gp 2 std cap chair |
26 |
25 |
$2K |
| T4536 |
Reusable pull-on any size |
113 |
113 |
$1K |
| K0006 |
Heavy duty wheelchair |
38 |
38 |
$896.55 |
| E0261 |
Hosp bed semi-electr w/o mat |
92 |
92 |
$835.74 |
| K0004 |
High strength ltwt whlchr |
72 |
72 |
$766.44 |
| A7005 |
Nondisposable nebulizer set |
134 |
133 |
$545.67 |
| A4628 |
Oropharyngeal suction cath |
27 |
27 |
$296.52 |
| E0163 |
Commode chair with fixed arm |
13 |
13 |
$215.48 |
| E0156 |
Walker seat attachment |
25 |
25 |
$65.94 |