| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,877 |
2,704 |
$264K |
| A4554 |
Disposable underpads, all sizes |
4,729 |
4,468 |
$241K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,567 |
2,413 |
$227K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,466 |
2,327 |
$214K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,545 |
2,427 |
$210K |
| A4927 |
Gloves, non-sterile, per 100 |
6,988 |
6,568 |
$103K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
382 |
357 |
$31K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
159 |
129 |
$10K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
184 |
175 |
$10K |
| K0003 |
Lightweight wheelchair |
556 |
529 |
$6K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
38 |
38 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
22 |
16 |
$1K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
48 |
38 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
41 |
39 |
$1K |
| A4259 |
Lancets, per box of 100 |
15 |
12 |
$215.12 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
24 |
16 |
$174.00 |