| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
15,010 |
14,929 |
$622K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
7,161 |
7,129 |
$555K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
11,788 |
11,748 |
$476K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,970 |
3,946 |
$322K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,846 |
3,832 |
$227K |
| A6244 |
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
549 |
544 |
$221K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,490 |
2,477 |
$50K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
281 |
278 |
$43K |
| A4927 |
Gloves, non-sterile, per 100 |
8,668 |
8,598 |
$29K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
441 |
439 |
$27K |
| A6236 |
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
69 |
64 |
$26K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
314 |
309 |
$24K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
756 |
749 |
$21K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
232 |
226 |
$19K |
| K0003 |
Lightweight wheelchair |
984 |
981 |
$13K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
253 |
250 |
$8K |
| E0241 |
Bath tub wall rail, each |
171 |
168 |
$8K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
282 |
280 |
$8K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
444 |
439 |
$6K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
24 |
24 |
$5K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
344 |
340 |
$4K |
| E0243 |
Toilet rail, each |
42 |
41 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,540 |
1,536 |
$2K |
| K0001 |
Standard wheelchair |
134 |
134 |
$2K |
| E0244 |
Raised toilet seat |
100 |
97 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
25 |
25 |
$1K |
| A4402 |
Lubricant, per ounce |
264 |
262 |
$1K |
| E0156 |
Seat attachment, walker |
139 |
138 |
$1K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
25 |
25 |
$872.44 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
38 |
37 |
$779.86 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
26 |
26 |
$569.33 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
26 |
26 |
$369.07 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
25 |
25 |
$194.44 |
| K0004 |
High strength, lightweight wheelchair |
12 |
12 |
$124.31 |