| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
6,302 |
6,302 |
$306K |
| T4522 |
Adult size brief/diaper med |
1,259 |
1,259 |
$111K |
| T4523 |
Adult size brief/diaper lg |
1,198 |
1,198 |
$103K |
| T4535 |
Disposable liner/shield/pad |
3,348 |
3,348 |
$84K |
| T4527 |
Adult size pull-on lg |
1,090 |
1,090 |
$80K |
| T4526 |
Adult size pull-on med |
1,211 |
1,211 |
$65K |
| K0003 |
Lightweight wheelchair |
6,267 |
6,259 |
$52K |
| T4537 |
Reusable underpad bed size |
998 |
998 |
$27K |
| E0630 |
Patient lift hydraulic |
573 |
570 |
$10K |
| E0295 |
Hosp bed semi-elect w/o matt |
598 |
596 |
$10K |
| E0973 |
W/ch access det adj armrest |
303 |
302 |
$8K |
| E2611 |
Gen use back cush wdth <22in |
202 |
202 |
$7K |
| E1038 |
Transport chair pt wt<=300lb |
1,246 |
1,246 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
271 |
265 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
204 |
202 |
$3K |
| E0260 |
Hosp bed semi-electr w/ matt |
439 |
439 |
$3K |
| E0163 |
Commode chair with fixed arm |
130 |
128 |
$2K |
| E0961 |
Wheelchair brake extension |
202 |
202 |
$2K |
| T4528 |
Adult size pull-on xl |
24 |
24 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
202 |
202 |
$2K |
| E0305 |
Rails bed side half length |
538 |
535 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
200 |
200 |
$920.82 |
| K0739 |
Repair/svc dme non-oxygen eq |
132 |
127 |
$705.06 |
| K0069 |
Rr whl compl sol tire rep ea |
24 |
24 |
$704.15 |
| E0185 |
Gel pressure mattress pad |
12 |
12 |
$544.10 |
| K0195 |
Elevating whlchair leg rests |
166 |
165 |
$504.99 |
| E2206 |
Man wc whl lock comp repl ea |
26 |
26 |
$271.41 |
| E2226 |
Caster fork replacement only |
24 |
24 |
$245.32 |
| E2222 |
Solid caster integ whl, repl |
25 |
25 |
$101.49 |
| E0981 |
Seat upholstery, replacement |
25 |
25 |
$64.37 |
| E0982 |
Back upholstery, replacement |
25 |
25 |
$62.28 |
| E0181 |
Press pad alternating w/ pum |
12 |
12 |
$44.68 |
| K0462 |
Temporary replacement eqpmnt |
31 |
31 |
$0.00 |
| E0156 |
Walker seat attachment |
12 |
12 |
$0.00 |
| E2311 |
Electro connect btw 2 sys |
12 |
12 |
$0.00 |
| E1007 |
Pwr seat combo w/shear |
12 |
12 |
$0.00 |
| E2313 |
Pwc harness, expand control |
12 |
12 |
$0.00 |
| E0261 |
Hosp bed semi-electr w/o mat |
12 |
12 |
$0.00 |
| E2377 |
Expandable controller, initl |
12 |
12 |
$0.00 |
| E1010 |
Add pwr leg elevation |
12 |
12 |
$0.00 |