| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
22,453 |
22,439 |
$1.01M |
| T4535 |
Disposable liner/shield/pad |
20,052 |
20,039 |
$785K |
| T4527 |
Adult size pull-on lg |
6,493 |
6,489 |
$402K |
| T4528 |
Adult size pull-on xl |
5,085 |
5,079 |
$346K |
| T4526 |
Adult size pull-on med |
6,201 |
6,199 |
$337K |
| E1390 |
Oxygen concentrator |
1,500 |
1,411 |
$264K |
| A6250 |
Skin seal protect moisturizr |
8,693 |
8,686 |
$136K |
| A4927 |
Non-sterile gloves |
5,840 |
5,838 |
$106K |
| K0001 |
Standard wheelchair |
2,140 |
1,956 |
$89K |
| A9900 |
Supply/accessory/service |
4,683 |
4,680 |
$89K |
| E0601 |
Cont airway pressure device |
667 |
665 |
$57K |
| T4523 |
Adult size brief/diaper lg |
854 |
853 |
$57K |
| A4335 |
Incontinence supply |
3,644 |
3,638 |
$43K |
| T4522 |
Adult size brief/diaper med |
531 |
531 |
$41K |
| E0431 |
Portable gaseous 02 |
1,106 |
1,105 |
$37K |
| K0195 |
Elevating whlchair leg rests |
2,369 |
2,102 |
$37K |
| T4536 |
Reusable pull-on any size |
2,351 |
2,347 |
$25K |
| T4524 |
Adult size brief/diaper xl |
291 |
290 |
$24K |
| E0971 |
Wheelchair anti-tipping devi |
2,901 |
2,543 |
$22K |
| E0604 |
Hosp grade elec breast pump |
322 |
260 |
$16K |
| E1238 |
Fld ped wc adjstabl w/o seat |
64 |
64 |
$9K |
| E0978 |
W/c acc,saf belt pelv strap |
3,019 |
2,661 |
$9K |
| E1226 |
Manual fully reclining back |
130 |
130 |
$5K |
| A7034 |
Nasal application device |
24 |
24 |
$2K |
| T4525 |
Adult size pull-on sm |
13 |
13 |
$2K |
| A7038 |
Pos airway pressure filter |
208 |
208 |
$2K |
| A7035 |
Pos airway press headgear |
70 |
70 |
$2K |
| A7037 |
Pos airway pressure tubing |
27 |
27 |
$564.53 |