| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
617 |
563 |
$24K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
271 |
243 |
$13K |
| A4927 |
Gloves, non-sterile, per 100 |
911 |
793 |
$11K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
30 |
29 |
$4K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
281 |
269 |
$2K |
| K0003 |
Lightweight wheelchair |
61 |
61 |
$480.00 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
26 |
26 |
$190.02 |