| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
19,892 |
19,835 |
$1.09M |
| T4535 |
Disposable liner/shield/pad |
10,972 |
10,481 |
$532K |
| T4527 |
Adult size pull-on lg |
5,589 |
5,479 |
$331K |
| T4526 |
Adult size pull-on med |
6,347 |
6,346 |
$315K |
| E1399 |
Durable medical equipment mi |
2,863 |
2,327 |
$303K |
| T4523 |
Adult size brief/diaper lg |
3,392 |
3,391 |
$274K |
| T4528 |
Adult size pull-on xl |
2,637 |
2,604 |
$155K |
| T4524 |
Adult size brief/diaper xl |
1,371 |
1,368 |
$103K |
| T4522 |
Adult size brief/diaper med |
1,321 |
1,320 |
$95K |
| A9286 |
Any hygienic item, device |
4,778 |
4,769 |
$79K |
| A4927 |
Non-sterile gloves |
2,559 |
2,559 |
$50K |
| E0144 |
Enclosed walker w rear seat |
140 |
140 |
$36K |
| E1390 |
Oxygen concentrator |
220 |
214 |
$33K |
| E0245 |
Tub stool or bench |
490 |
488 |
$25K |
| A9901 |
Delivery/set up/dispensing |
268 |
247 |
$21K |
| T4525 |
Adult size pull-on sm |
368 |
368 |
$18K |
| E0143 |
Walker folding wheeled w/o s |
260 |
257 |
$15K |
| E0246 |
Transfer tub rail attachment |
370 |
369 |
$14K |
| E0156 |
Walker seat attachment |
476 |
476 |
$8K |
| A6250 |
Skin seal protect moisturizr |
547 |
547 |
$6K |
| E0297 |
Hosp bed total elect w/o mat |
61 |
61 |
$6K |
| A4335 |
Incontinence supply |
574 |
574 |
$5K |
| E0601 |
Cont airway pressure device |
54 |
54 |
$4K |
| K0001 |
Standard wheelchair |
165 |
159 |
$4K |
| E0305 |
Rails bed side half length |
138 |
137 |
$2K |
| E0271 |
Mattress innerspring |
114 |
113 |
$2K |
| E0431 |
Portable gaseous 02 |
40 |
38 |
$1K |
| K0739 |
Repair/svc dme non-oxygen eq |
17 |
12 |
$1K |
| T4537 |
Reusable underpad bed size |
47 |
47 |
$1K |
| T4536 |
Reusable pull-on any size |
76 |
76 |
$786.71 |
| E0163 |
Commode chair with fixed arm |
13 |
13 |
$712.93 |
| A9999 |
Dme supply or accessory, nos |
15 |
12 |
$222.52 |