| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
14,903 |
13,724 |
$889K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,081 |
5,610 |
$693K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,065 |
4,668 |
$593K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,606 |
2,435 |
$383K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
5,759 |
2,703 |
$372K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,932 |
2,685 |
$297K |
| A4927 |
Gloves, non-sterile, per 100 |
13,414 |
12,158 |
$256K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
6,667 |
2,986 |
$118K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
261 |
246 |
$26K |
| K0001 |
Standard wheelchair |
5,018 |
2,193 |
$21K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
196 |
136 |
$18K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
884 |
393 |
$12K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
91 |
88 |
$12K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
276 |
161 |
$11K |
| E0277 |
Powered pressure-reducing air mattress |
73 |
37 |
$8K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
21 |
12 |
$5K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
24 |
24 |
$3K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
15 |
12 |
$1K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
413 |
157 |
$534.86 |
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
20 |
13 |
$380.96 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
375 |
167 |
$342.75 |
| E2395 |
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
20 |
13 |
$314.21 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
21 |
14 |
$244.47 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
72 |
37 |
$67.46 |