| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
206 |
177 |
$9K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
57 |
55 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
448 |
403 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
97 |
79 |
$2K |
| K0003 |
Lightweight wheelchair |
119 |
119 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
25 |
24 |
$509.95 |
| A4335 |
Incontinence supply; miscellaneous |
314 |
258 |
$357.28 |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$330.22 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
170 |
165 |
$304.25 |