| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
18,938 |
18,796 |
$786K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
7,571 |
7,514 |
$644K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
16,757 |
16,634 |
$612K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,589 |
3,568 |
$286K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
8,106 |
8,027 |
$228K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
5,819 |
5,775 |
$163K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,986 |
1,977 |
$128K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
580 |
579 |
$61K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
2,914 |
2,882 |
$46K |
| A4927 |
Gloves, non-sterile, per 100 |
7,684 |
7,597 |
$31K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
738 |
733 |
$19K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
697 |
692 |
$4K |
| K0003 |
Lightweight wheelchair |
506 |
506 |
$3K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
265 |
263 |
$3K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
38 |
20 |
$2K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
29 |
15 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
678 |
678 |
$503.48 |