| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
357 |
357 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
129 |
129 |
$8K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
78 |
78 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
94 |
87 |
$3K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
109 |
109 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
47 |
43 |
$2K |
| K0001 |
Standard wheelchair |
84 |
84 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
14 |
13 |
$1K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
25 |
25 |
$164.40 |
| A4335 |
Incontinence supply; miscellaneous |
12 |
12 |
$31.80 |