| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
31,703 |
31,597 |
$872K |
| T4535 |
Disposable liner/shield/pad |
20,731 |
20,500 |
$610K |
| T4527 |
Adult size pull-on lg |
9,272 |
9,259 |
$322K |
| T4526 |
Adult size pull-on med |
7,119 |
7,115 |
$217K |
| T4528 |
Adult size pull-on xl |
5,819 |
5,809 |
$174K |
| T4523 |
Adult size brief/diaper lg |
3,885 |
3,858 |
$164K |
| T4524 |
Adult size brief/diaper xl |
2,138 |
2,095 |
$74K |
| T4522 |
Adult size brief/diaper med |
1,374 |
1,368 |
$64K |
| T4537 |
Reusable underpad bed size |
2,481 |
2,477 |
$44K |
| K0001 |
Standard wheelchair |
1,865 |
1,735 |
$29K |
| A6250 |
Skin seal protect moisturizr |
1,508 |
1,497 |
$20K |
| T4536 |
Reusable pull-on any size |
1,371 |
1,370 |
$10K |
| A4335 |
Incontinence supply |
4,360 |
4,202 |
$9K |
| T4525 |
Adult size pull-on sm |
245 |
245 |
$9K |
| K0195 |
Elevating whlchair leg rests |
890 |
780 |
$7K |
| A4927 |
Non-sterile gloves |
1,051 |
1,042 |
$6K |
| A4520 |
Incontinence garment anytype |
2,476 |
2,464 |
$4K |
| E0143 |
Walker folding wheeled w/o s |
1,205 |
1,178 |
$4K |
| E0245 |
Tub stool or bench |
588 |
586 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
1,064 |
862 |
$3K |
| E0570 |
Nebulizer with compression |
594 |
590 |
$2K |
| A4554 |
Disposable underpads |
1,236 |
1,229 |
$1K |
| E0247 |
Trans bench w/wo comm open |
66 |
64 |
$350.20 |
| K0003 |
Lightweight wheelchair |
13 |
13 |
$50.29 |
| E0261 |
Hosp bed semi-electr w/o mat |
332 |
332 |
$0.00 |