| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,577 |
1,393 |
$131K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,719 |
3,412 |
$128K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,797 |
1,659 |
$127K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,242 |
1,181 |
$100K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
778 |
692 |
$66K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
962 |
839 |
$27K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
432 |
409 |
$19K |
| K0816 |
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
556 |
537 |
$18K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
817 |
795 |
$10K |
| E0277 |
Powered pressure-reducing air mattress |
272 |
247 |
$8K |
| K0001 |
Standard wheelchair |
1,096 |
1,041 |
$7K |
| K0002 |
Standard hemi (low seat) wheelchair |
352 |
342 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
194 |
180 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
31 |
26 |
$3K |
| E0251 |
Hospital bed, fixed height, with any type side rails, without mattress |
237 |
224 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
90 |
88 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
295 |
294 |
$1K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
24 |
24 |
$956.40 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
14 |
14 |
$109.55 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
13 |
13 |
$105.48 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
13 |
13 |
$77.12 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$76.86 |
| A9270 |
Non-covered item or service |
12 |
12 |
$0.00 |