| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
617 |
350 |
$40K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
393 |
218 |
$23K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
394 |
386 |
$17K |
| E0570 |
Nebulizer, with compressor |
541 |
482 |
$9K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
254 |
222 |
$8K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
109 |
87 |
$6K |
| K0003 |
Lightweight wheelchair |
742 |
728 |
$5K |
| K0001 |
Standard wheelchair |
194 |
193 |
$966.77 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
12 |
12 |
$522.70 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
13 |
12 |
$177.89 |