| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
5,272 |
5,115 |
$165K |
| X1939 |
|
2,167 |
2,144 |
$131K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,424 |
1,342 |
$91K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,516 |
1,440 |
$73K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,325 |
1,301 |
$62K |
| T5999 |
Supply, not otherwise specified |
7,908 |
7,634 |
$43K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
878 |
864 |
$25K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
25 |
24 |
$3K |
| E0601 |
Continuous positive airway pressure (cpap) device |
69 |
56 |
$3K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
37 |
37 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
21 |
21 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
26 |
26 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
31 |
26 |
$1K |
| K0001 |
Standard wheelchair |
71 |
61 |
$229.36 |