| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
96 |
96 |
$15K |
| A4670 |
Automatic blood pressure monitor |
82 |
82 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
123 |
123 |
$2K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
67 |
64 |
$784.74 |
| A4335 |
Incontinence supply; miscellaneous |
151 |
151 |
$310.61 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
35 |
35 |
$57.82 |
| E1639 |
Scale, each |
13 |
13 |
$55.92 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
17 |
17 |
$38.45 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
13 |
13 |
$25.64 |