| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
1,673 |
1,641 |
$198K |
| T4528 |
Adult size pull-on xl |
1,203 |
1,180 |
$190K |
| T4526 |
Adult size pull-on med |
916 |
889 |
$113K |
| T4523 |
Adult size brief/diaper lg |
514 |
499 |
$105K |
| T4535 |
Disposable liner/shield/pad |
841 |
813 |
$91K |
| T4541 |
Large disposable underpad |
1,172 |
1,153 |
$54K |
| E0260 |
Hosp bed semi-electr w/ matt |
873 |
849 |
$50K |
| A4927 |
Non-sterile gloves |
1,537 |
1,488 |
$46K |
| T4524 |
Adult size brief/diaper xl |
171 |
169 |
$40K |
| E1028 |
W/c manual swingaway |
675 |
530 |
$31K |
| K0823 |
Pwc gp 2 std cap chair |
135 |
133 |
$28K |
| K0739 |
Repair/svc dme non-oxygen eq |
496 |
469 |
$28K |
| T4544 |
Adlt disp und/pull on abv xl |
124 |
121 |
$26K |
| K0108 |
W/c component-accessory nos |
164 |
90 |
$26K |
| K0001 |
Standard wheelchair |
951 |
912 |
$25K |
| E0601 |
Cont airway pressure device |
278 |
273 |
$13K |
| E0630 |
Patient lift hydraulic |
187 |
185 |
$10K |
| E1161 |
Manual adult wc w tiltinspac |
13 |
13 |
$7K |
| B4150 |
Ef complet w/intact nutrient |
72 |
62 |
$5K |
| T4522 |
Adult size brief/diaper med |
28 |
28 |
$5K |
| E0562 |
Humidifier heated used w pap |
252 |
250 |
$4K |
| T2029 |
Special med equip, noswaiver |
12 |
12 |
$1K |
| A7031 |
Replacement facemask interfa |
14 |
14 |
$501.97 |
| A4604 |
Tubing with heating element |
13 |
13 |
$484.09 |
| A7038 |
Pos airway pressure filter |
54 |
54 |
$258.02 |