| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
12,806 |
11,138 |
$491K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,834 |
4,312 |
$420K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,298 |
3,784 |
$377K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,454 |
5,634 |
$373K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,358 |
3,927 |
$371K |
| A4927 |
Gloves, non-sterile, per 100 |
8,801 |
7,827 |
$96K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
855 |
771 |
$64K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
460 |
399 |
$38K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,146 |
861 |
$32K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
156 |
149 |
$13K |
| K0001 |
Standard wheelchair |
1,426 |
1,131 |
$9K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
206 |
134 |
$4K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
16 |
12 |
$791.12 |