| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
18,653 |
18,145 |
$1.31M |
| T4527 |
Adult size pull-on lg |
6,450 |
6,255 |
$1.07M |
| T4528 |
Adult size pull-on xl |
5,239 |
5,084 |
$884K |
| T4526 |
Adult size pull-on med |
5,187 |
5,059 |
$881K |
| A4554 |
Disposable underpads |
16,768 |
16,292 |
$735K |
| A4927 |
Non-sterile gloves |
18,650 |
18,139 |
$576K |
| T4543 |
Adult disp brief/diap abv xl |
1,273 |
1,255 |
$386K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,217 |
702 |
$264K |
| T4541 |
Large disposable underpad |
1,900 |
1,858 |
$94K |
| W5514 |
|
347 |
334 |
$91K |
| K0823 |
Pwc gp 2 std cap chair |
449 |
439 |
$18K |
| E2370 |
Pwr wc dr wh motor/gear comb |
328 |
283 |
$16K |
| E2375 |
Non-expandable controller |
161 |
156 |
$6K |
| E2366 |
Battery charger, single mode |
364 |
329 |
$3K |
| E2374 |
Hand/chin ctrl std joystick |
115 |
108 |
$2K |
| E2386 |
Foam filled drive wheel tire |
51 |
51 |
$993.94 |
| E2394 |
Drive wheel excludes tire |
51 |
51 |
$566.98 |
| E2392 |
Solid caster tire, integrate |
39 |
39 |
$556.59 |
| E2365 |
U1 sealed leadacid battery |
108 |
107 |
$366.34 |