| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
3,257 |
3,121 |
$106K |
| T4527 |
Adult size pull-on lg |
1,092 |
1,053 |
$78K |
| T4526 |
Adult size pull-on med |
899 |
868 |
$68K |
| E2361 |
22nf sealed leadacid battery |
227 |
214 |
$49K |
| T4523 |
Adult size brief/diaper lg |
398 |
391 |
$34K |
| T4528 |
Adult size pull-on xl |
335 |
321 |
$29K |
| T4535 |
Disposable liner/shield/pad |
1,116 |
1,063 |
$25K |
| E2366 |
Battery charger, single mode |
124 |
117 |
$21K |
| E2386 |
Foam filled drive wheel tire |
93 |
88 |
$20K |
| T4522 |
Adult size brief/diaper med |
281 |
273 |
$17K |
| E2387 |
Foam filled caster tire |
138 |
132 |
$13K |
| T4524 |
Adult size brief/diaper xl |
148 |
147 |
$13K |
| A4456 |
Adhesive remover, wipes |
887 |
850 |
$10K |
| K0739 |
Repair/svc dme non-oxygen eq |
152 |
145 |
$9K |
| T4544 |
Adlt disp und/pull on abv xl |
38 |
37 |
$9K |
| A4612 |
Battery cables |
124 |
117 |
$8K |
| E0260 |
Hosp bed semi-electr w/ matt |
308 |
303 |
$7K |
| T4525 |
Adult size pull-on sm |
41 |
39 |
$3K |
| K0195 |
Elevating whlchair leg rests |
133 |
131 |
$3K |
| E0982 |
Back upholstery, replacement |
62 |
62 |
$2K |
| E0981 |
Seat upholstery, replacement |
62 |
62 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
131 |
120 |
$2K |
| A5500 |
Diab shoe for density insert |
26 |
13 |
$1K |
| K0816 |
Pwc gp 1 std cap chair |
25 |
25 |
$1K |
| K0042 |
Standard size ftplate rep ea |
12 |
12 |
$698.88 |
| E0994 |
Wheelchair arm rest |
14 |
14 |
$545.44 |
| K0019 |
Arm pad repl, each |
14 |
14 |
$404.32 |