| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary catheter, with insertion supplies |
2,453 |
2,096 |
$1.38M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,246 |
3,758 |
$730K |
| E1220 |
Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification |
90 |
81 |
$616K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,631 |
2,335 |
$270K |
| E1399 |
Durable medical equipment, miscellaneous |
150 |
86 |
$138K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
531 |
268 |
$63K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
629 |
516 |
$59K |
| K0003 |
Lightweight wheelchair |
1,506 |
1,364 |
$48K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
252 |
103 |
$45K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
469 |
394 |
$39K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
935 |
381 |
$30K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
176 |
162 |
$19K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
129 |
128 |
$13K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
30 |
25 |
$4K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
48 |
40 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
54 |
41 |
$977.80 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
14 |
12 |
$878.58 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
13 |
12 |
$314.22 |