| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
10,228 |
9,632 |
$605K |
| T4527 |
Adult size pull-on lg |
4,744 |
4,475 |
$469K |
| T4528 |
Adult size pull-on xl |
3,637 |
3,454 |
$424K |
| T4541 |
Large disposable underpad |
8,733 |
8,228 |
$372K |
| T4526 |
Adult size pull-on med |
3,850 |
3,605 |
$333K |
| T4543 |
Adult disp brief/diap abv xl |
1,267 |
1,197 |
$179K |
| T1999 |
Noc retail items andsupplies |
757 |
712 |
$125K |
| T4537 |
Reusable underpad bed size |
735 |
733 |
$80K |
| T4525 |
Adult size pull-on sm |
895 |
841 |
$72K |
| T4523 |
Adult size brief/diaper lg |
237 |
222 |
$32K |
| A4927 |
Non-sterile gloves |
646 |
596 |
$25K |
| K0823 |
Pwc gp 2 std cap chair |
270 |
270 |
$24K |
| E1399 |
Durable medical equipment mi |
388 |
365 |
$21K |
| E0260 |
Hosp bed semi-electr w/ matt |
732 |
732 |
$19K |
| A4335 |
Incontinence supply |
315 |
294 |
$11K |
| E1028 |
W/c manual swingaway |
495 |
441 |
$9K |
| K0001 |
Standard wheelchair |
299 |
299 |
$3K |
| E0240 |
Bath/shower chair |
28 |
28 |
$2K |
| B4150 |
Ef complet w/intact nutrient |
14 |
12 |
$1K |
| E0630 |
Patient lift hydraulic |
39 |
39 |
$1K |
| K0739 |
Repair/svc dme non-oxygen eq |
55 |
51 |
$871.64 |
| E0910 |
Trapeze bar attached to bed |
68 |
68 |
$260.30 |