| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
50,343 |
47,945 |
$1.70M |
| X1939 |
|
22,430 |
22,283 |
$1.40M |
| T5999 |
Supply, not otherwise specified |
104,405 |
92,874 |
$1.01M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
17,018 |
16,018 |
$929K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12,663 |
11,944 |
$881K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
5,721 |
5,262 |
$757K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,726 |
6,505 |
$688K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12,846 |
11,999 |
$673K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
18,445 |
17,970 |
$563K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,832 |
4,893 |
$488K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
4,060 |
3,669 |
$450K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
13,331 |
13,283 |
$399K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,964 |
3,371 |
$379K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,467 |
2,275 |
$286K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,726 |
2,662 |
$268K |
| A4927 |
Gloves, non-sterile, per 100 |
10,571 |
5,972 |
$132K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
994 |
931 |
$115K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
988 |
981 |
$69K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
532 |
518 |
$55K |
| X1922 |
|
239 |
217 |
$34K |
| X1915 |
|
290 |
279 |
$25K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
484 |
311 |
$19K |
| E0244 |
Raised toilet seat |
184 |
182 |
$18K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
269 |
268 |
$17K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
79 |
75 |
$9K |
| E0570 |
Nebulizer, with compressor |
537 |
341 |
$9K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
79 |
79 |
$6K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
13 |
13 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
35 |
12 |
$2K |
| K0001 |
Standard wheelchair |
67 |
36 |
$1K |