| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
9,180 |
9,121 |
$332K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,262 |
2,251 |
$331K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,241 |
1,235 |
$224K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,542 |
1,533 |
$180K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,389 |
2,358 |
$100K |
| A4335 |
Incontinence supply; miscellaneous |
9,804 |
9,722 |
$52K |
| K0003 |
Lightweight wheelchair |
1,156 |
1,149 |
$24K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
640 |
640 |
$20K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
799 |
798 |
$18K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
51 |
49 |
$4K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
116 |
112 |
$4K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
37 |
37 |
$4K |
| E0570 |
Nebulizer, with compressor |
26 |
26 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
69 |
69 |
$804.48 |