| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
35,473 |
34,293 |
$1.99M |
| T4528 |
Adult size pull-on xl |
12,906 |
12,484 |
$1.50M |
| T4527 |
Adult size pull-on lg |
14,720 |
14,289 |
$1.44M |
| T4526 |
Adult size pull-on med |
13,842 |
13,462 |
$1.19M |
| T4541 |
Large disposable underpad |
26,822 |
25,681 |
$1.06M |
| T4543 |
Adult disp brief/diap abv xl |
3,981 |
3,850 |
$661K |
| T1999 |
Noc retail items andsupplies |
2,516 |
2,428 |
$420K |
| T4537 |
Reusable underpad bed size |
4,787 |
4,712 |
$414K |
| E1399 |
Durable medical equipment mi |
1,020 |
994 |
$189K |
| B4150 |
Ef complet w/intact nutrient |
1,311 |
1,263 |
$179K |
| T4525 |
Adult size pull-on sm |
2,502 |
2,452 |
$175K |
| T4524 |
Adult size brief/diaper xl |
922 |
871 |
$134K |
| B4152 |
Ef calorie dense>/=1.5kcal |
699 |
672 |
$124K |
| A4927 |
Non-sterile gloves |
4,921 |
4,708 |
$101K |
| B4154 |
Ef spec metabolic noninherit |
421 |
406 |
$95K |
| T4544 |
Adlt disp und/pull on abv xl |
483 |
474 |
$94K |
| K0823 |
Pwc gp 2 std cap chair |
841 |
840 |
$88K |
| A4335 |
Incontinence supply |
2,035 |
1,873 |
$82K |
| T4522 |
Adult size brief/diaper med |
662 |
622 |
$78K |
| T4523 |
Adult size brief/diaper lg |
559 |
534 |
$76K |
| S5165 |
Home modifications per serv |
491 |
491 |
$64K |
| E0240 |
Bath/shower chair |
511 |
511 |
$62K |
| E1390 |
Oxygen concentrator |
918 |
918 |
$61K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,209 |
1,204 |
$43K |
| K0001 |
Standard wheelchair |
1,394 |
1,392 |
$35K |
| T4542 |
Small disposable underpad |
1,109 |
1,082 |
$34K |
| S5161 |
Emer rspns sys serv permonth |
738 |
722 |
$26K |
| E0630 |
Patient lift hydraulic |
696 |
693 |
$18K |
| E0241 |
Bath tub wall rail |
94 |
79 |
$12K |
| E0244 |
Toilet seat raised |
119 |
119 |
$11K |
| E0431 |
Portable gaseous 02 |
352 |
352 |
$4K |
| A5512 |
Multi den insert direct form |
60 |
43 |
$3K |
| E0247 |
Trans bench w/wo comm open |
24 |
24 |
$3K |
| E0246 |
Transfer tub rail attachment |
40 |
40 |
$3K |
| A5500 |
Diab shoe for density insert |
60 |
43 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
40 |
40 |
$2K |
| K0195 |
Elevating whlchair leg rests |
546 |
545 |
$2K |
| K0003 |
Lightweight wheelchair |
27 |
27 |
$136.63 |