| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
5,921 |
5,879 |
$1.25M |
| A4554 |
Disposable underpads, all sizes |
16,296 |
16,222 |
$727K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
5,203 |
5,176 |
$526K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
11,052 |
11,029 |
$360K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,334 |
4,324 |
$342K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
7,264 |
7,199 |
$217K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
8,127 |
8,062 |
$212K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,662 |
2,638 |
$201K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,969 |
1,447 |
$159K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
5,290 |
5,255 |
$86K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
479 |
365 |
$46K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
323 |
272 |
$21K |
| A4927 |
Gloves, non-sterile, per 100 |
4,031 |
3,989 |
$18K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
33 |
26 |
$2K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
12 |
12 |
$1K |
| K0001 |
Standard wheelchair |
186 |
184 |
$839.88 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
143 |
142 |
$213.27 |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$15.07 |