| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
6,302 |
6,302 |
$306K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,259 |
1,259 |
$111K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,198 |
1,198 |
$103K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,348 |
3,348 |
$84K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,090 |
1,090 |
$80K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,211 |
1,211 |
$65K |
| K0003 |
Lightweight wheelchair |
6,267 |
6,259 |
$52K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
998 |
998 |
$27K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
573 |
570 |
$10K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
598 |
596 |
$10K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
303 |
302 |
$8K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
202 |
202 |
$7K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,246 |
1,246 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
271 |
265 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
204 |
202 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
439 |
439 |
$3K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
130 |
128 |
$2K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
202 |
202 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
24 |
24 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
202 |
202 |
$2K |
| E0305 |
Bed side rails, half length |
538 |
535 |
$1K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
200 |
200 |
$920.82 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
132 |
127 |
$705.06 |
| K0069 |
Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each |
24 |
24 |
$704.15 |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
12 |
12 |
$544.10 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
166 |
165 |
$504.99 |
| E2206 |
Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each |
26 |
26 |
$271.41 |
| E2226 |
Manual wheelchair accessory, caster fork, any size, replacement only, each |
24 |
24 |
$245.32 |
| E2222 |
Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
25 |
25 |
$101.49 |
| E0981 |
Wheelchair accessory, seat upholstery, replacement only, each |
25 |
25 |
$64.37 |
| E0982 |
Wheelchair accessory, back upholstery, replacement only, each |
25 |
25 |
$62.28 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
12 |
12 |
$44.68 |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
31 |
31 |
$0.00 |
| E0156 |
Seat attachment, walker |
12 |
12 |
$0.00 |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
12 |
12 |
$0.00 |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
12 |
12 |
$0.00 |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
12 |
12 |
$0.00 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
12 |
12 |
$0.00 |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
12 |
12 |
$0.00 |
| E1010 |
Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair |
12 |
12 |
$0.00 |