| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
3,257 |
3,121 |
$106K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,092 |
1,053 |
$78K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
899 |
868 |
$68K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
227 |
214 |
$49K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
398 |
391 |
$34K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
335 |
321 |
$29K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,116 |
1,063 |
$25K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
124 |
117 |
$21K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
93 |
88 |
$20K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
281 |
273 |
$17K |
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
138 |
132 |
$13K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
148 |
147 |
$13K |
| A4456 |
Adhesive remover, wipes, any type, each |
887 |
850 |
$10K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
152 |
145 |
$9K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
38 |
37 |
$9K |
| A4612 |
Battery cables; replacement for patient-owned ventilator |
124 |
117 |
$8K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
308 |
303 |
$7K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
41 |
39 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
133 |
131 |
$3K |
| E0982 |
Wheelchair accessory, back upholstery, replacement only, each |
62 |
62 |
$2K |
| E0981 |
Wheelchair accessory, seat upholstery, replacement only, each |
62 |
62 |
$2K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
131 |
120 |
$2K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
26 |
13 |
$1K |
| K0816 |
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
25 |
25 |
$1K |
| K0042 |
Standard size footplate, replacement only, each |
12 |
12 |
$698.88 |
| E0994 |
Arm rest, each |
14 |
14 |
$545.44 |
| K0019 |
Arm pad, replacement only, each |
14 |
14 |
$404.32 |