| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary cath |
9,019 |
7,653 |
$4.34M |
| E1399 |
Durable medical equipment mi |
2,175 |
1,363 |
$3.18M |
| K0108 |
W/c component-accessory nos |
3,469 |
2,072 |
$784K |
| T4534 |
Youth size pull-on |
3,119 |
2,995 |
$282K |
| A4351 |
Straight tip urine catheter |
3,040 |
2,445 |
$242K |
| E1028 |
W/c manual swingaway |
3,309 |
1,598 |
$171K |
| K0009 |
Other manual wheelchair/base |
33 |
27 |
$168K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,128 |
3,278 |
$157K |
| A4554 |
Disposable underpads |
6,535 |
6,046 |
$156K |
| T4522 |
Adult size brief/diaper med |
1,449 |
1,399 |
$82K |
| T4532 |
Ped size pull-on lg |
881 |
867 |
$80K |
| A4927 |
Non-sterile gloves |
5,966 |
5,481 |
$78K |
| T4530 |
Ped size brief/diaper lg |
916 |
842 |
$71K |
| T4526 |
Adult size pull-on med |
902 |
831 |
$57K |
| T4523 |
Adult size brief/diaper lg |
691 |
648 |
$48K |
| A5120 |
Skin barrier, wipe or swab |
6,998 |
6,439 |
$48K |
| A4349 |
Disposable male external cat |
2,415 |
1,684 |
$46K |
| E0955 |
Cushioned headrest |
830 |
639 |
$31K |
| E0973 |
W/ch access det adj armrest |
445 |
275 |
$23K |
| T4521 |
Adult size brief/diaper sm |
359 |
350 |
$21K |
| K0823 |
Pwc gp 2 std cap chair |
278 |
235 |
$20K |
| T4527 |
Adult size pull-on lg |
319 |
298 |
$20K |
| T4525 |
Adult size pull-on sm |
132 |
131 |
$18K |
| A4357 |
Bedside drainage bag |
3,194 |
2,392 |
$16K |
| A4322 |
Irrigation syringe |
561 |
490 |
$16K |
| E0956 |
W/c lateral trunk/hip suppor |
191 |
114 |
$13K |
| T4535 |
Disposable liner/shield/pad |
617 |
580 |
$12K |
| E0960 |
W/c shoulder harness/straps |
263 |
211 |
$11K |
| A4358 |
Urinary leg or abdomen bag |
2,381 |
1,685 |
$9K |
| T4533 |
Youth size brief/diaper |
78 |
75 |
$8K |
| A4310 |
Insert tray w/o bag/cath |
300 |
241 |
$7K |
| E2607 |
Skin pro/pos wc cus wd <22in |
84 |
63 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
470 |
362 |
$6K |
| A4332 |
Lube sterile packet |
851 |
654 |
$5K |
| K0040 |
Adjustable angle footplate |
125 |
89 |
$5K |
| E0971 |
Wheelchair anti-tipping devi |
138 |
99 |
$4K |
| A4335 |
Incontinence supply |
162 |
142 |
$4K |
| A4352 |
Coude tip urinary catheter |
15 |
12 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
165 |
149 |
$3K |
| E2613 |
Position back cush wd <22in |
13 |
12 |
$3K |
| A4344 |
Cath indw foley 2 way silicn |
30 |
24 |
$2K |
| A4520 |
Incontinence garment anytype |
48 |
37 |
$2K |
| T4528 |
Adult size pull-on xl |
12 |
12 |
$1K |
| T4524 |
Adult size brief/diaper xl |
12 |
12 |
$1K |
| E1161 |
Manual adult wc w tiltinspac |
19 |
12 |
$677.22 |
| A4402 |
Lubricant per ounce |
507 |
386 |
$605.03 |
| E2366 |
Battery charger, single mode |
20 |
13 |
$565.40 |
| A4247 |
Betadine/iodine swabs/wipes |
25 |
24 |
$333.41 |
| E0951 |
Loop heel |
16 |
12 |
$216.16 |