| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
1,401 |
1,282 |
$66K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
714 |
652 |
$44K |
| A4927 |
Gloves, non-sterile, per 100 |
1,751 |
1,590 |
$39K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
103 |
103 |
$18K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
146 |
139 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
220 |
213 |
$295.40 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
40 |
36 |
$255.15 |
| K0004 |
High strength, lightweight wheelchair |
41 |
36 |
$126.51 |