| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,415 |
587 |
$890K |
| K0108 |
W/c component-accessory nos |
3,850 |
1,627 |
$534K |
| A6250 |
Skin seal protect moisturizr |
2,492 |
2,442 |
$436K |
| T4523 |
Adult size brief/diaper lg |
1,717 |
1,712 |
$290K |
| A4554 |
Disposable underpads |
2,839 |
2,762 |
$272K |
| E1028 |
W/c manual swingaway |
3,887 |
2,048 |
$261K |
| T4524 |
Adult size brief/diaper xl |
1,150 |
1,147 |
$216K |
| E1161 |
Manual adult wc w tiltinspac |
1,214 |
1,035 |
$189K |
| A4927 |
Non-sterile gloves |
5,258 |
5,184 |
$134K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,399 |
1,997 |
$74K |
| E0955 |
Cushioned headrest |
1,706 |
1,368 |
$65K |
| E0973 |
W/ch access det adj armrest |
810 |
545 |
$48K |
| A5120 |
Skin barrier, wipe or swab |
3,997 |
3,954 |
$41K |
| K0823 |
Pwc gp 2 std cap chair |
280 |
259 |
$37K |
| K0040 |
Adjustable angle footplate |
747 |
512 |
$36K |
| E0956 |
W/c lateral trunk/hip suppor |
465 |
263 |
$34K |
| E0960 |
W/c shoulder harness/straps |
545 |
436 |
$24K |
| E0978 |
W/c acc,saf belt pelv strap |
799 |
654 |
$15K |
| E0971 |
Wheelchair anti-tipping devi |
475 |
306 |
$13K |
| E2607 |
Skin pro/pos wc cus wd <22in |
69 |
48 |
$8K |
| A4928 |
Surgical mask |
508 |
506 |
$6K |
| T4522 |
Adult size brief/diaper med |
52 |
49 |
$5K |
| E0950 |
Tray |
85 |
71 |
$4K |
| T4535 |
Disposable liner/shield/pad |
100 |
98 |
$4K |
| E2361 |
22nf sealed leadacid battery |
33 |
27 |
$4K |
| A4670 |
Automatic bp monitor, dial |
33 |
33 |
$3K |
| E2613 |
Position back cush wd <22in |
18 |
12 |
$3K |
| E2213 |
Pneumatic prop tire insert |
68 |
39 |
$1K |
| E0961 |
Wheelchair brake extension |
27 |
24 |
$766.73 |
| E0951 |
Loop heel |
67 |
41 |
$677.74 |
| E2219 |
Foam caster tire any size ea |
18 |
13 |
$571.51 |
| E2211 |
Pneumatic propulsion tire |
18 |
14 |
$542.68 |
| A4931 |
Reusable oral thermometer |
33 |
33 |
$320.00 |
| K0038 |
Leg strap each |
12 |
12 |
$200.16 |