| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,003 |
2,717 |
$129K |
| A4927 |
Gloves, non-sterile, per 100 |
2,900 |
2,604 |
$60K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
568 |
524 |
$51K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
446 |
414 |
$37K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
147 |
137 |
$13K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
16 |
13 |
$5K |
| E1070 |
Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest |
89 |
64 |
$3K |
| K0001 |
Standard wheelchair |
15 |
13 |
$77.87 |