| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
12,494 |
9,659 |
$367K |
| T4527 |
Adult size pull-on lg |
4,543 |
3,524 |
$288K |
| T4526 |
Adult size pull-on med |
3,384 |
2,626 |
$203K |
| T4528 |
Adult size pull-on xl |
2,672 |
2,059 |
$195K |
| T4523 |
Adult size brief/diaper lg |
2,130 |
1,604 |
$123K |
| T4524 |
Adult size brief/diaper xl |
930 |
705 |
$74K |
| E1390 |
Oxygen concentrator |
2,132 |
1,975 |
$70K |
| T4522 |
Adult size brief/diaper med |
1,117 |
868 |
$54K |
| K0823 |
Pwc gp 2 std cap chair |
321 |
308 |
$50K |
| K0001 |
Standard wheelchair |
1,281 |
1,139 |
$27K |
| E0570 |
Nebulizer with compression |
1,861 |
1,641 |
$20K |
| E0261 |
Hosp bed semi-electr w/o mat |
1,316 |
1,183 |
$18K |
| E0431 |
Portable gaseous 02 |
2,135 |
1,977 |
$14K |
| T4525 |
Adult size pull-on sm |
131 |
111 |
$9K |
| E0601 |
Cont airway pressure device |
232 |
224 |
$6K |
| E0143 |
Walker folding wheeled w/o s |
162 |
139 |
$5K |
| E0260 |
Hosp bed semi-electr w/ matt |
192 |
170 |
$5K |
| E0295 |
Hosp bed semi-elect w/o matt |
112 |
109 |
$4K |
| E0562 |
Humidifier heated used w pap |
316 |
305 |
$3K |
| K0003 |
Lightweight wheelchair |
13 |
12 |
$1K |
| E0240 |
Bath/shower chair |
13 |
13 |
$534.05 |
| A7003 |
Nebulizer administration set |
432 |
353 |
$400.45 |
| E0973 |
W/ch access det adj armrest |
12 |
12 |
$316.07 |
| A7037 |
Pos airway pressure tubing |
13 |
12 |
$283.05 |
| E1038 |
Transport chair pt wt<=300lb |
99 |
89 |
$182.74 |
| A7038 |
Pos airway pressure filter |
27 |
26 |
$137.60 |
| E0978 |
W/c acc,saf belt pelv strap |
13 |
12 |
$97.96 |
| E2365 |
U1 sealed leadacid battery |
13 |
12 |
$65.68 |
| K0195 |
Elevating whlchair leg rests |
12 |
12 |
$52.36 |