| Code | Description | Claims | Beneficiaries | Total Paid |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,753 |
2,751 |
$504K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,349 |
3,347 |
$500K |
| A4554 |
Disposable underpads, all sizes |
8,729 |
8,714 |
$337K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,427 |
1,425 |
$314K |
| A4335 |
Incontinence supply; miscellaneous |
8,843 |
8,819 |
$50K |
| K0003 |
Lightweight wheelchair |
1,387 |
1,359 |
$22K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,547 |
1,514 |
$6K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
13 |
13 |
$4K |