| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4544 |
Adlt disp und/pull on abv xl |
2,288 |
2,277 |
$696K |
| T4527 |
Adult size pull-on lg |
3,263 |
3,244 |
$528K |
| A4554 |
Disposable underpads |
11,328 |
11,163 |
$403K |
| T4526 |
Adult size pull-on med |
2,704 |
2,691 |
$383K |
| T4528 |
Adult size pull-on xl |
1,647 |
1,622 |
$335K |
| A4335 |
Incontinence supply |
11,613 |
11,573 |
$64K |
| A6250 |
Skin seal protect moisturizr |
7,738 |
7,709 |
$50K |
| K0002 |
Stnd hemi (low seat) whlchr |
2,367 |
2,313 |
$21K |
| K0195 |
Elevating whlchair leg rests |
3,661 |
3,584 |
$10K |
| K0001 |
Standard wheelchair |
1,418 |
1,413 |
$10K |
| E0260 |
Hosp bed semi-electr w/ matt |
452 |
442 |
$10K |
| T4523 |
Adult size brief/diaper lg |
69 |
67 |
$8K |
| T4524 |
Adult size brief/diaper xl |
530 |
521 |
$7K |
| T4535 |
Disposable liner/shield/pad |
194 |
193 |
$5K |
| E0295 |
Hosp bed semi-elect w/o matt |
1,750 |
1,735 |
$5K |
| E0630 |
Patient lift hydraulic |
310 |
307 |
$5K |
| K0003 |
Lightweight wheelchair |
195 |
192 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
40 |
39 |
$419.95 |
| E2601 |
Gen w/c cushion wdth < 22 in |
40 |
39 |
$369.84 |
| E0990 |
Wheelchair elevating leg res |
38 |
37 |
$165.41 |
| E0143 |
Walker folding wheeled w/o s |
14 |
14 |
$135.48 |