| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,656 |
3,619 |
$135K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,036 |
1,033 |
$127K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
773 |
764 |
$88K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
710 |
705 |
$78K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,892 |
1,861 |
$63K |
| A4335 |
Incontinence supply; miscellaneous |
4,197 |
4,153 |
$23K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
288 |
285 |
$12K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
356 |
355 |
$12K |
| K0001 |
Standard wheelchair |
539 |
533 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
263 |
261 |
$2K |