| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
14,903 |
13,724 |
$889K |
| T4527 |
Adult size pull-on lg |
6,081 |
5,610 |
$693K |
| T4528 |
Adult size pull-on xl |
5,065 |
4,668 |
$593K |
| T4544 |
Adlt disp und/pull on abv xl |
2,606 |
2,435 |
$383K |
| K0823 |
Pwc gp 2 std cap chair |
5,759 |
2,703 |
$372K |
| T4526 |
Adult size pull-on med |
2,932 |
2,685 |
$297K |
| A4927 |
Non-sterile gloves |
13,414 |
12,158 |
$256K |
| E0260 |
Hosp bed semi-electr w/ matt |
6,667 |
2,986 |
$118K |
| T4523 |
Adult size brief/diaper lg |
261 |
246 |
$26K |
| K0001 |
Standard wheelchair |
5,018 |
2,193 |
$21K |
| E2363 |
Gr24 sealed leadacid battery |
196 |
136 |
$18K |
| E0630 |
Patient lift hydraulic |
884 |
393 |
$12K |
| T4534 |
Youth size pull-on |
91 |
88 |
$12K |
| E0973 |
W/ch access det adj armrest |
276 |
161 |
$11K |
| E0277 |
Powered pres-redu air mattrs |
73 |
37 |
$8K |
| K0825 |
Pwc gp 2 hd cap chair |
21 |
12 |
$5K |
| T4543 |
Adult disp brief/diap abv xl |
24 |
24 |
$3K |
| T4525 |
Adult size pull-on sm |
15 |
12 |
$1K |
| E1038 |
Transport chair pt wt<=300lb |
413 |
157 |
$534.86 |
| E2387 |
Foam filled caster tire |
20 |
13 |
$380.96 |
| E0910 |
Trapeze bar attached to bed |
375 |
167 |
$342.75 |
| E2395 |
Caster wheel excludes tire |
20 |
13 |
$314.21 |
| K0739 |
Repair/svc dme non-oxygen eq |
21 |
14 |
$244.47 |
| K0195 |
Elevating whlchair leg rests |
72 |
37 |
$67.46 |