| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,410 |
2,403 |
$523K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,460 |
1,455 |
$262K |
| A4554 |
Disposable underpads, all sizes |
4,653 |
4,630 |
$173K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
4,335 |
4,320 |
$27K |
| A4335 |
Incontinence supply; miscellaneous |
4,648 |
4,631 |
$26K |
| K0004 |
High strength, lightweight wheelchair |
210 |
210 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
220 |
220 |
$681.82 |
| E0570 |
Nebulizer, with compressor |
136 |
136 |
$93.86 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
76 |
74 |
$54.50 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
12 |
12 |
$21.96 |