| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,518 |
1,518 |
$264K |
| A4554 |
Disposable underpads, all sizes |
2,918 |
2,908 |
$111K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
429 |
429 |
$96K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
585 |
585 |
$84K |
| A4335 |
Incontinence supply; miscellaneous |
3,827 |
3,691 |
$20K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,476 |
2,441 |
$19K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
166 |
166 |
$5K |
| A4259 |
Lancets, per box of 100 |
2,468 |
2,437 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
51 |
51 |
$379.46 |
| K0003 |
Lightweight wheelchair |
12 |
12 |
$173.26 |