| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,879 |
408 |
$798K |
| K0108 |
W/c component-accessory nos |
8,033 |
1,814 |
$695K |
| S5165 |
Home modifications per serv |
162 |
120 |
$573K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
780 |
718 |
$215K |
| T2029 |
Special med equip, noswaiver |
174 |
140 |
$158K |
| E1161 |
Manual adult wc w tiltinspac |
1,963 |
1,099 |
$147K |
| E1028 |
W/c manual swingaway |
10,031 |
3,108 |
$145K |
| T4526 |
Adult size pull-on med |
1,796 |
1,741 |
$144K |
| T5999 |
Supply, nos |
820 |
731 |
$130K |
| B9998 |
Enteral supp not otherwise c |
727 |
572 |
$122K |
| T4522 |
Adult size brief/diaper med |
1,714 |
1,581 |
$110K |
| K0739 |
Repair/svc dme non-oxygen eq |
6,252 |
4,099 |
$106K |
| B4100 |
Food thickener oral |
741 |
661 |
$94K |
| T4527 |
Adult size pull-on lg |
1,224 |
1,190 |
$92K |
| T4534 |
Youth size pull-on |
1,003 |
955 |
$83K |
| T4535 |
Disposable liner/shield/pad |
2,957 |
2,737 |
$79K |
| T4541 |
Large disposable underpad |
3,651 |
3,470 |
$79K |
| B4035 |
Enteral feed supp pump per d |
563 |
432 |
$77K |
| T4528 |
Adult size pull-on xl |
945 |
891 |
$72K |
| T4523 |
Adult size brief/diaper lg |
840 |
800 |
$69K |
| A4927 |
Non-sterile gloves |
3,671 |
3,245 |
$64K |
| B4161 |
Ef ped hydrolyzed/amino acid |
88 |
80 |
$44K |
| E0955 |
Cushioned headrest |
3,105 |
1,786 |
$42K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,448 |
1,670 |
$40K |
| A4335 |
Incontinence supply |
868 |
719 |
$21K |
| T4525 |
Adult size pull-on sm |
339 |
312 |
$20K |
| K0823 |
Pwc gp 2 std cap chair |
571 |
276 |
$19K |
| E0973 |
W/ch access det adj armrest |
582 |
229 |
$18K |
| B4150 |
Ef complet w/intact nutrient |
211 |
167 |
$15K |
| T4521 |
Adult size brief/diaper sm |
237 |
213 |
$13K |
| T4537 |
Reusable underpad bed size |
826 |
770 |
$11K |
| K0040 |
Adjustable angle footplate |
541 |
214 |
$11K |
| T4533 |
Youth size brief/diaper |
120 |
116 |
$9K |
| A9286 |
Any hygienic item, device |
700 |
427 |
$8K |
| T4530 |
Ped size brief/diaper lg |
72 |
65 |
$8K |
| E0956 |
W/c lateral trunk/hip suppor |
213 |
70 |
$7K |
| E0277 |
Powered pres-redu air mattrs |
38 |
38 |
$6K |
| B4034 |
Enter feed supkit syr by day |
29 |
24 |
$4K |
| E0630 |
Patient lift hydraulic |
205 |
164 |
$4K |
| T4524 |
Adult size brief/diaper xl |
48 |
43 |
$4K |
| B4088 |
Gastro/jejuno tube, low-pro |
56 |
39 |
$4K |
| K0004 |
High strength ltwt whlchr |
289 |
131 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
260 |
153 |
$3K |
| E0971 |
Wheelchair anti-tipping devi |
90 |
40 |
$2K |
| E0265 |
Hosp bed total electr w/ mat |
14 |
13 |
$2K |
| B4152 |
Ef calorie dense>/=1.5kcal |
16 |
13 |
$2K |
| E2607 |
Skin pro/pos wc cus wd <22in |
30 |
12 |
$1K |
| E2211 |
Pneumatic propulsion tire |
65 |
24 |
$567.40 |
| K0195 |
Elevating whlchair leg rests |
375 |
164 |
$489.04 |
| E2213 |
Pneumatic prop tire insert |
37 |
12 |
$263.92 |
| K0001 |
Standard wheelchair |
13 |
12 |
$165.90 |
| A4357 |
Bedside drainage bag |
54 |
25 |
$157.88 |
| E0951 |
Loop heel |
38 |
12 |
$116.94 |