| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
7,256 |
6,495 |
$426K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,583 |
2,426 |
$405K |
| E1399 |
Durable medical equipment, miscellaneous |
494 |
307 |
$394K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,125 |
1,967 |
$296K |
| A4927 |
Gloves, non-sterile, per 100 |
6,995 |
6,517 |
$278K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,248 |
1,211 |
$206K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
652 |
617 |
$101K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
125 |
114 |
$16K |
| K0004 |
High strength, lightweight wheelchair |
1,101 |
522 |
$8K |
| K0001 |
Standard wheelchair |
741 |
345 |
$3K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
138 |
82 |
$902.63 |
| A4452 |
Tape, waterproof, per 18 square inches |
29 |
25 |
$469.03 |
| A4456 |
Adhesive remover, wipes, any type, each |
18 |
17 |
$375.00 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
127 |
62 |
$135.61 |