| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
15,010 |
14,929 |
$622K |
| T4523 |
Adult size brief/diaper lg |
7,161 |
7,129 |
$555K |
| T4535 |
Disposable liner/shield/pad |
11,788 |
11,748 |
$476K |
| T4524 |
Adult size brief/diaper xl |
3,970 |
3,946 |
$322K |
| T4522 |
Adult size brief/diaper med |
3,846 |
3,832 |
$227K |
| A6244 |
Hydrogel drg >48 in w/o bdr |
549 |
544 |
$221K |
| T4537 |
Reusable underpad bed size |
2,490 |
2,477 |
$50K |
| T4543 |
Adult disp brief/diap abv xl |
281 |
278 |
$43K |
| A4927 |
Non-sterile gloves |
8,668 |
8,598 |
$29K |
| E1390 |
Oxygen concentrator |
441 |
439 |
$27K |
| A6236 |
Hydrocolld drg > 48 in w/o b |
69 |
64 |
$26K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
314 |
309 |
$24K |
| T4539 |
Reuse diaper/brief any size |
756 |
749 |
$21K |
| E0247 |
Trans bench w/wo comm open |
232 |
226 |
$19K |
| K0003 |
Lightweight wheelchair |
984 |
981 |
$13K |
| E0240 |
Bath/shower chair |
253 |
250 |
$8K |
| E0241 |
Bath tub wall rail |
171 |
168 |
$8K |
| E0143 |
Walker folding wheeled w/o s |
282 |
280 |
$8K |
| E0431 |
Portable gaseous 02 |
444 |
439 |
$6K |
| A5057 |
1 pc ost pou w built-in conv |
24 |
24 |
$5K |
| T4540 |
Reusable underpad chair size |
344 |
340 |
$4K |
| E0243 |
Toilet rail |
42 |
41 |
$3K |
| K0195 |
Elevating whlchair leg rests |
1,540 |
1,536 |
$2K |
| K0001 |
Standard wheelchair |
134 |
134 |
$2K |
| E0244 |
Toilet seat raised |
100 |
97 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
25 |
25 |
$1K |
| A4402 |
Lubricant per ounce |
264 |
262 |
$1K |
| E0156 |
Walker seat attachment |
139 |
138 |
$1K |
| E0973 |
W/ch access det adj armrest |
25 |
25 |
$872.44 |
| A6402 |
Sterile gauze <= 16 sq in |
38 |
37 |
$779.86 |
| E0971 |
Wheelchair anti-tipping devi |
26 |
26 |
$569.33 |
| E2601 |
Gen w/c cushion wdth < 22 in |
26 |
26 |
$369.07 |
| E0978 |
W/c acc,saf belt pelv strap |
25 |
25 |
$194.44 |
| K0004 |
High strength ltwt whlchr |
12 |
12 |
$124.31 |