| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
552 |
530 |
$36K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
129 |
129 |
$19K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
36 |
36 |
$6K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
41 |
41 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
83 |
83 |
$4K |
| A4930 |
Gloves, sterile, per pair |
57 |
55 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
124 |
120 |
$979.40 |
| A4670 |
Automatic blood pressure monitor |
13 |
12 |
$671.82 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
169 |
167 |
$583.85 |
| K0004 |
High strength, lightweight wheelchair |
25 |
25 |
$248.84 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$96.30 |
| A4259 |
Lancets, per box of 100 |
169 |
167 |
$50.37 |
| E0156 |
Seat attachment, walker |
12 |
12 |
$27.09 |
| A4258 |
Spring-powered device for lancet, each |
13 |
13 |
$5.40 |