| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
4,246 |
4,134 |
$270K |
| T4528 |
Adult size pull-on xl |
1,362 |
1,329 |
$169K |
| T4526 |
Adult size pull-on med |
1,674 |
1,642 |
$159K |
| T4527 |
Adult size pull-on lg |
1,481 |
1,457 |
$157K |
| T4541 |
Large disposable underpad |
2,615 |
2,576 |
$138K |
| T1999 |
Noc retail items andsupplies |
598 |
572 |
$109K |
| T4543 |
Adult disp brief/diap abv xl |
462 |
450 |
$84K |
| T4537 |
Reusable underpad bed size |
323 |
323 |
$34K |
| T4525 |
Adult size pull-on sm |
324 |
315 |
$26K |
| E1399 |
Durable medical equipment mi |
279 |
269 |
$25K |
| T4523 |
Adult size brief/diaper lg |
110 |
104 |
$20K |
| K0823 |
Pwc gp 2 std cap chair |
212 |
212 |
$19K |
| T4524 |
Adult size brief/diaper xl |
87 |
82 |
$15K |
| A4335 |
Incontinence supply |
180 |
145 |
$14K |
| T4542 |
Small disposable underpad |
300 |
296 |
$13K |
| T4522 |
Adult size brief/diaper med |
104 |
95 |
$13K |
| S5161 |
Emer rspns sys serv permonth |
358 |
355 |
$13K |
| E0241 |
Bath tub wall rail |
80 |
54 |
$9K |
| E0240 |
Bath/shower chair |
104 |
104 |
$9K |
| A4927 |
Non-sterile gloves |
194 |
162 |
$6K |
| E1390 |
Oxygen concentrator |
100 |
100 |
$5K |
| K0001 |
Standard wheelchair |
185 |
184 |
$4K |
| K0825 |
Pwc gp 2 hd cap chair |
12 |
12 |
$4K |
| E0247 |
Trans bench w/wo comm open |
27 |
27 |
$4K |
| B4152 |
Ef calorie dense>/=1.5kcal |
15 |
12 |
$3K |
| A5512 |
Multi den insert direct form |
18 |
18 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
64 |
64 |
$2K |
| A5500 |
Diab shoe for density insert |
18 |
18 |
$1K |
| E0244 |
Toilet seat raised |
14 |
14 |
$1K |
| K0003 |
Lightweight wheelchair |
89 |
89 |
$918.59 |
| E0246 |
Transfer tub rail attachment |
13 |
13 |
$825.00 |
| E0143 |
Walker folding wheeled w/o s |
25 |
25 |
$476.37 |
| K0195 |
Elevating whlchair leg rests |
107 |
107 |
$409.79 |
| A7003 |
Nebulizer administration set |
12 |
12 |
$40.04 |