| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,921 |
1,843 |
$197K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,524 |
1,481 |
$158K |
| A4554 |
Disposable underpads, all sizes |
2,946 |
2,833 |
$150K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
763 |
726 |
$79K |
| A4927 |
Gloves, non-sterile, per 100 |
2,016 |
1,948 |
$33K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
214 |
204 |
$17K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
94 |
89 |
$6K |
| K0003 |
Lightweight wheelchair |
233 |
227 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
51 |
39 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
12 |
12 |
$168.97 |