| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
327 |
323 |
$56K |
| A4554 |
Disposable underpads, all sizes |
331 |
327 |
$12K |
| K0003 |
Lightweight wheelchair |
565 |
565 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
691 |
684 |
$2K |
| K0001 |
Standard wheelchair |
75 |
75 |
$338.12 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
62 |
61 |
$136.08 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
302 |
295 |
$9.90 |