| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult size brief/diaper lg |
916 |
867 |
$152K |
| T4527 |
Adult size pull-on lg |
1,072 |
1,030 |
$142K |
| T4528 |
Adult size pull-on xl |
874 |
857 |
$134K |
| T4535 |
Disposable liner/shield/pad |
880 |
843 |
$89K |
| T4526 |
Adult size pull-on med |
687 |
662 |
$83K |
| T4522 |
Adult size brief/diaper med |
606 |
575 |
$83K |
| T4541 |
Large disposable underpad |
1,127 |
1,098 |
$51K |
| E0260 |
Hosp bed semi-electr w/ matt |
788 |
758 |
$45K |
| E1028 |
W/c manual swingaway |
793 |
600 |
$29K |
| T4534 |
Youth size pull-on |
212 |
194 |
$27K |
| K0739 |
Repair/svc dme non-oxygen eq |
438 |
397 |
$21K |
| E0630 |
Patient lift hydraulic |
245 |
236 |
$13K |
| A4927 |
Non-sterile gloves |
357 |
348 |
$11K |
| K0001 |
Standard wheelchair |
459 |
432 |
$10K |
| T4525 |
Adult size pull-on sm |
66 |
64 |
$8K |
| T4524 |
Adult size brief/diaper xl |
31 |
30 |
$6K |
| K0108 |
W/c component-accessory nos |
50 |
26 |
$5K |
| K0823 |
Pwc gp 2 std cap chair |
12 |
12 |
$4K |
| E1161 |
Manual adult wc w tiltinspac |
12 |
12 |
$4K |
| E0261 |
Hosp bed semi-electr w/o mat |
75 |
66 |
$3K |
| A7038 |
Pos airway pressure filter |
190 |
187 |
$935.36 |
| E0955 |
Cushioned headrest |
25 |
24 |
$749.88 |
| A4604 |
Tubing with heating element |
13 |
12 |
$506.02 |