| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,191 |
3,176 |
$114K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
432 |
425 |
$68K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
477 |
470 |
$65K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
111 |
109 |
$20K |
| A4335 |
Incontinence supply; miscellaneous |
3,323 |
3,313 |
$18K |
| K0003 |
Lightweight wheelchair |
65 |
62 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
91 |
89 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
104 |
76 |
$0.00 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
121 |
92 |
$0.00 |