| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
697 |
656 |
$37K |
| A4927 |
Gloves, non-sterile, per 100 |
1,777 |
1,591 |
$27K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
274 |
235 |
$13K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
44 |
38 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
267 |
236 |
$3K |
| K0001 |
Standard wheelchair |
265 |
231 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
174 |
137 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
30 |
26 |
$222.64 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
103 |
76 |
$115.50 |