| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,746 |
2,382 |
$150K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
381 |
223 |
$36K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
283 |
153 |
$24K |
| K0001 |
Standard wheelchair |
2,024 |
1,229 |
$10K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
94 |
49 |
$7K |
| E0570 |
Nebulizer, with compressor |
288 |
219 |
$3K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
313 |
259 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
495 |
281 |
$784.25 |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
23 |
13 |
$142.59 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
15 |
12 |
$140.22 |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
38 |
26 |
$117.17 |