| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,109 |
1,094 |
$269K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,738 |
1,716 |
$173K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,447 |
1,437 |
$142K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,558 |
1,532 |
$129K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,576 |
1,560 |
$78K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,193 |
3,167 |
$65K |
| A4927 |
Gloves, non-sterile, per 100 |
2,014 |
1,994 |
$49K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
772 |
760 |
$30K |
| A4554 |
Disposable underpads, all sizes |
1,147 |
1,132 |
$13K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
202 |
202 |
$8K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
31 |
27 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
41 |
41 |
$333.74 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
157 |
156 |
$205.36 |
| K0003 |
Lightweight wheelchair |
12 |
12 |
$50.52 |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$8.86 |