| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
1,577 |
1,393 |
$131K |
| T4541 |
Large disposable underpad |
3,719 |
3,412 |
$128K |
| T4526 |
Adult size pull-on med |
1,797 |
1,659 |
$127K |
| T4527 |
Adult size pull-on lg |
1,242 |
1,181 |
$100K |
| T4522 |
Adult size brief/diaper med |
778 |
692 |
$66K |
| T4535 |
Disposable liner/shield/pad |
962 |
839 |
$27K |
| K0823 |
Pwc gp 2 std cap chair |
432 |
409 |
$19K |
| K0816 |
Pwc gp 1 std cap chair |
556 |
537 |
$18K |
| E0250 |
Hosp bed fixed ht w/ mattres |
817 |
795 |
$10K |
| E0277 |
Powered pres-redu air mattrs |
272 |
247 |
$8K |
| K0001 |
Standard wheelchair |
1,096 |
1,041 |
$7K |
| K0002 |
Stnd hemi (low seat) whlchr |
352 |
342 |
$4K |
| E0260 |
Hosp bed semi-electr w/ matt |
194 |
180 |
$3K |
| T4523 |
Adult size brief/diaper lg |
31 |
26 |
$3K |
| E0251 |
Hosp bed fixd ht w/o mattres |
237 |
224 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
90 |
88 |
$2K |
| E1038 |
Transport chair pt wt<=300lb |
295 |
294 |
$1K |
| K0825 |
Pwc gp 2 hd cap chair |
24 |
24 |
$956.40 |
| E0978 |
W/c acc,saf belt pelv strap |
14 |
14 |
$109.55 |
| E0951 |
Loop heel |
13 |
13 |
$105.48 |
| E0961 |
Wheelchair brake extension |
13 |
13 |
$77.12 |
| E2601 |
Gen w/c cushion wdth < 22 in |
12 |
12 |
$76.86 |
| A9270 |
Non-covered item or service |
12 |
12 |
$0.00 |