| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
72,828 |
71,949 |
$5.40M |
| T4523 |
Adult size brief/diaper lg |
25,864 |
25,542 |
$2.94M |
| T4537 |
Reusable underpad bed size |
81,219 |
80,258 |
$2.66M |
| T4524 |
Adult size brief/diaper xl |
17,951 |
17,694 |
$2.20M |
| T4522 |
Adult size brief/diaper med |
23,049 |
22,801 |
$2.07M |
| T4539 |
Reuse diaper/brief any size |
66,006 |
65,184 |
$2.06M |
| E0603 |
Electric breast pump |
12,172 |
12,159 |
$1.93M |
| T4540 |
Reusable underpad chair size |
78,514 |
77,569 |
$1.41M |
| T4541 |
Large disposable underpad |
15,817 |
15,765 |
$1.30M |
| T4535 |
Disposable liner/shield/pad |
34,081 |
33,645 |
$1.16M |
| A6250 |
Skin seal protect moisturizr |
14,515 |
14,494 |
$632K |
| L2630 |
Pelvic control band & belt u |
2,187 |
2,178 |
$498K |
| A4927 |
Non-sterile gloves |
91,174 |
90,110 |
$399K |
| T4526 |
Adult size pull-on med |
2,124 |
2,123 |
$398K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
1,550 |
1,549 |
$394K |
| T4543 |
Adult disp brief/diap abv xl |
2,083 |
2,074 |
$375K |
| T4533 |
Youth size brief/diaper |
4,660 |
4,649 |
$343K |
| A6539 |
Gc stocking waistlngth 18-30 |
1,089 |
1,015 |
$288K |
| T4521 |
Adult size brief/diaper sm |
3,393 |
3,378 |
$267K |
| A6540 |
Gc stocking waistlngth 30-40 |
678 |
624 |
$211K |
| L0621 |
Sio flex pelvic/sacr pre ots |
2,044 |
2,012 |
$146K |
| A4239 |
Non-adju cgm supply allow |
1,033 |
1,024 |
$140K |
| A5120 |
Skin barrier, wipe or swab |
12,837 |
12,807 |
$121K |
| A4335 |
Incontinence supply |
6,077 |
6,070 |
$94K |
| A6530 |
Compression stocking bk18-30 |
1,345 |
1,184 |
$61K |
| E2611 |
Gen use back cush wdth <22in |
860 |
858 |
$52K |
| A6537 |
Gc stocking full lngth 30-40 |
246 |
118 |
$51K |
| K0001 |
Standard wheelchair |
4,722 |
4,717 |
$45K |
| L0649 |
Lso sc r pos/lat pnl pre ots |
226 |
226 |
$40K |
| E0247 |
Trans bench w/wo comm open |
450 |
448 |
$40K |
| A9999 |
Dme supply or accessory, nos |
4,386 |
3,269 |
$31K |
| E2103 |
Non-adju cgm receiver/mon |
313 |
311 |
$29K |
| E0143 |
Walker folding wheeled w/o s |
957 |
955 |
$26K |
| E0240 |
Bath/shower chair |
652 |
649 |
$24K |
| A4402 |
Lubricant per ounce |
3,897 |
3,889 |
$22K |
| K0003 |
Lightweight wheelchair |
935 |
934 |
$22K |
| T4530 |
Ped size brief/diaper lg |
324 |
324 |
$20K |
| E0971 |
Wheelchair anti-tipping devi |
1,602 |
907 |
$18K |
| B4150 |
Ef complet w/intact nutrient |
203 |
203 |
$17K |
| E0630 |
Patient lift hydraulic |
479 |
479 |
$14K |
| K1005 |
Disp col sto bag breast milk |
280 |
276 |
$12K |
| E1390 |
Oxygen concentrator |
383 |
383 |
$10K |
| E2601 |
Gen w/c cushion wdth < 22 in |
834 |
832 |
$10K |
| E0241 |
Bath tub wall rail |
257 |
255 |
$9K |
| E0163 |
Commode chair with fixed arm |
411 |
409 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,526 |
1,526 |
$8K |
| K0195 |
Elevating whlchair leg rests |
5,617 |
5,607 |
$8K |
| E0961 |
Wheelchair brake extension |
876 |
874 |
$6K |
| A4670 |
Automatic bp monitor, dial |
115 |
114 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
779 |
779 |
$5K |
| E0156 |
Walker seat attachment |
525 |
525 |
$4K |
| E0185 |
Gel pressure mattress pad |
65 |
64 |
$2K |
| E1399 |
Durable medical equipment mi |
346 |
345 |
$2K |
| E0431 |
Portable gaseous 02 |
348 |
347 |
$2K |
| A4510 |
Full length surg stocking |
13 |
12 |
$2K |
| E0244 |
Toilet seat raised |
70 |
70 |
$1K |
| K0006 |
Heavy duty wheelchair |
64 |
64 |
$1K |
| B4154 |
Ef spec metabolic noninherit |
12 |
12 |
$1K |
| E0149 |
Heavy duty wheeled walker |
39 |
39 |
$831.74 |
| E0973 |
W/ch access det adj armrest |
41 |
24 |
$604.67 |
| E0100 |
Cane adjust/fixed with tip |
50 |
49 |
$366.94 |
| E1038 |
Transport chair pt wt<=300lb |
205 |
205 |
$99.88 |