| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
3,700 |
3,511 |
$409K |
| T4537 |
Reusable underpad bed size |
9,516 |
9,127 |
$385K |
| T4528 |
Adult size pull-on xl |
3,523 |
3,386 |
$353K |
| T4535 |
Disposable liner/shield/pad |
6,863 |
6,588 |
$345K |
| T4526 |
Adult size pull-on med |
3,419 |
3,236 |
$338K |
| T4523 |
Adult size brief/diaper lg |
2,401 |
2,328 |
$322K |
| T4541 |
Large disposable underpad |
12,730 |
12,216 |
$275K |
| A4927 |
Non-sterile gloves |
12,627 |
11,557 |
$237K |
| T4534 |
Youth size pull-on |
1,462 |
1,408 |
$231K |
| T4543 |
Adult disp brief/diap abv xl |
860 |
805 |
$229K |
| T4522 |
Adult size brief/diaper med |
1,701 |
1,662 |
$229K |
| T4544 |
Adlt disp und/pull on abv xl |
1,116 |
1,049 |
$192K |
| T4524 |
Adult size brief/diaper xl |
1,386 |
1,348 |
$177K |
| E1399 |
Durable medical equipment mi |
55 |
49 |
$139K |
| K0108 |
W/c component-accessory nos |
991 |
714 |
$132K |
| E1028 |
W/c manual swingaway |
1,780 |
1,425 |
$89K |
| K0823 |
Pwc gp 2 std cap chair |
649 |
639 |
$88K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,483 |
2,399 |
$75K |
| W0137 |
|
187 |
185 |
$40K |
| B4150 |
Ef complet w/intact nutrient |
596 |
499 |
$33K |
| K0001 |
Standard wheelchair |
1,624 |
1,580 |
$28K |
| E1390 |
Oxygen concentrator |
484 |
477 |
$25K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,474 |
1,363 |
$22K |
| A4335 |
Incontinence supply |
1,515 |
1,229 |
$21K |
| E0955 |
Cushioned headrest |
468 |
431 |
$15K |
| E0570 |
Nebulizer with compression |
1,389 |
1,263 |
$15K |
| E1161 |
Manual adult wc w tiltinspac |
103 |
100 |
$13K |
| B4035 |
Enteral feed supp pump per d |
154 |
139 |
$12K |
| E0630 |
Patient lift hydraulic |
660 |
618 |
$12K |
| E0601 |
Cont airway pressure device |
330 |
277 |
$11K |
| E0973 |
W/ch access det adj armrest |
223 |
193 |
$10K |
| A4409 |
Ost skn barr convex <=4 sq i |
141 |
137 |
$9K |
| A4351 |
Straight tip urine catheter |
139 |
137 |
$8K |
| A4385 |
Ost skn barrier sld ext wear |
169 |
167 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
294 |
229 |
$8K |
| A6530 |
Compression stocking bk18-30 |
132 |
120 |
$7K |
| A4456 |
Adhesive remover, wipes |
822 |
773 |
$6K |
| E2361 |
22nf sealed leadacid battery |
55 |
49 |
$5K |
| A5120 |
Skin barrier, wipe or swab |
692 |
663 |
$4K |
| K0195 |
Elevating whlchair leg rests |
1,052 |
997 |
$4K |
| A4406 |
Pectin based ostomy paste |
441 |
418 |
$3K |
| E0562 |
Humidifier heated used w pap |
232 |
196 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
177 |
169 |
$3K |
| A4407 |
Ext wear ost skn barr <=4sq" |
26 |
25 |
$3K |
| A4425 |
Ost pch drain for barrier fl |
52 |
51 |
$2K |
| E0627 |
Seat lift mech, electric any |
12 |
12 |
$1K |
| A4357 |
Bedside drainage bag |
489 |
450 |
$1K |
| A4362 |
Solid skin barrier |
28 |
28 |
$1K |
| K0821 |
Pwc gp 2 std port cap chair |
12 |
12 |
$1K |
| A4554 |
Disposable underpads |
98 |
97 |
$986.70 |
| K0003 |
Lightweight wheelchair |
51 |
48 |
$959.89 |
| A6402 |
Sterile gauze <= 16 sq in |
59 |
50 |
$956.07 |
| A7030 |
Cpap full face mask |
13 |
13 |
$866.94 |
| A7038 |
Pos airway pressure filter |
148 |
133 |
$576.05 |
| A4349 |
Disposable male external cat |
25 |
12 |
$387.09 |
| A7037 |
Pos airway pressure tubing |
14 |
13 |
$200.70 |
| E2601 |
Gen w/c cushion wdth < 22 in |
12 |
12 |
$157.38 |
| A4358 |
Urinary leg or abdomen bag |
13 |
12 |
$36.74 |
| A4520 |
Incontinence garment anytype |
314 |
298 |
$0.00 |