| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0260 |
Hosp bed semi-electr w/ matt |
3,369 |
3,248 |
$283K |
| T4527 |
Adult size pull-on lg |
927 |
901 |
$101K |
| K0001 |
Standard wheelchair |
3,206 |
3,037 |
$96K |
| T4526 |
Adult size pull-on med |
709 |
694 |
$72K |
| T4523 |
Adult size brief/diaper lg |
557 |
509 |
$56K |
| T4541 |
Large disposable underpad |
3,190 |
3,010 |
$52K |
| E0630 |
Patient lift hydraulic |
942 |
883 |
$43K |
| T4522 |
Adult size brief/diaper med |
409 |
401 |
$42K |
| E0143 |
Walker folding wheeled w/o s |
639 |
619 |
$37K |
| A4927 |
Non-sterile gloves |
3,034 |
2,848 |
$36K |
| T4524 |
Adult size brief/diaper xl |
344 |
321 |
$32K |
| K0108 |
W/c component-accessory nos |
217 |
92 |
$28K |
| T4528 |
Adult size pull-on xl |
161 |
155 |
$17K |
| E0245 |
Tub stool or bench |
195 |
180 |
$17K |
| K0003 |
Lightweight wheelchair |
358 |
343 |
$16K |
| E0971 |
Wheelchair anti-tipping devi |
2,553 |
1,358 |
$14K |
| K0739 |
Repair/svc dme non-oxygen eq |
168 |
151 |
$9K |
| A9270 |
Non-covered item or service |
764 |
688 |
$9K |
| E1399 |
Durable medical equipment mi |
21 |
13 |
$9K |
| K0007 |
Extra heavy duty wheelchair |
51 |
48 |
$7K |
| K0195 |
Elevating whlchair leg rests |
669 |
597 |
$7K |
| K0006 |
Heavy duty wheelchair |
43 |
37 |
$4K |
| E0181 |
Press pad alternating w/ pum |
121 |
119 |
$1K |
| K0002 |
Stnd hemi (low seat) whlchr |
28 |
24 |
$1K |