| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
2,945 |
2,930 |
$161K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,111 |
1,105 |
$55K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
463 |
462 |
$41K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
505 |
502 |
$40K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
545 |
544 |
$33K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
227 |
227 |
$13K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
102 |
102 |
$7K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
74 |
74 |
$6K |
| K0005 |
Ultralightweight wheelchair |
12 |
12 |
$3K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
12 |
12 |
$309.21 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
12 |
12 |
$213.16 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
12 |
12 |
$112.80 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
12 |
12 |
$83.30 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$77.88 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
12 |
12 |
$48.95 |