| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
318 |
259 |
$30K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
89 |
89 |
$12K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
65 |
63 |
$9K |
| A5120 |
Skin barrier, wipes or swabs, each |
368 |
364 |
$4K |
| A4554 |
Disposable underpads, all sizes |
52 |
52 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
20 |
20 |
$905.49 |
| K0001 |
Standard wheelchair |
51 |
50 |
$415.55 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
135 |
129 |
$387.56 |
| A4335 |
Incontinence supply; miscellaneous |
58 |
58 |
$330.02 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
40 |
40 |
$206.40 |