| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
8,827 |
8,809 |
$315K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,707 |
2,704 |
$257K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,147 |
3,141 |
$255K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
7,138 |
7,123 |
$231K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,067 |
1,052 |
$124K |
| A4335 |
Incontinence supply; miscellaneous |
9,870 |
9,840 |
$55K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
472 |
448 |
$1K |
| A4670 |
Automatic blood pressure monitor |
13 |
13 |
$809.90 |
| K0001 |
Standard wheelchair |
64 |
64 |
$222.63 |
| A4259 |
Lancets, per box of 100 |
16 |
14 |
$4.48 |