| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
435 |
432 |
$10K |
| K0004 |
High strength, lightweight wheelchair |
266 |
263 |
$6K |
| T4541 |
Incontinence product, disposable underpad, large, each |
43 |
36 |
$3K |
| E0272 |
Mattress, foam rubber |
436 |
435 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
366 |
364 |
$1K |
| E0305 |
Bed side rails, half length |
438 |
435 |
$1K |
| K0006 |
Heavy duty wheelchair |
38 |
38 |
$369.45 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
42 |
36 |
$24.87 |
| A4335 |
Incontinence supply; miscellaneous |
43 |
36 |
$9.59 |