| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
1,266 |
1,262 |
$81K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
492 |
489 |
$43K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
414 |
414 |
$40K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
330 |
329 |
$35K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
33 |
33 |
$11K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
86 |
86 |
$8K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
47 |
24 |
$6K |
| K0003 |
Lightweight wheelchair |
27 |
27 |
$623.88 |
| A4927 |
Gloves, non-sterile, per 100 |
12 |
12 |
$179.98 |