| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
805 |
651 |
$83K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
672 |
633 |
$67K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
382 |
360 |
$30K |
| K0001 |
Standard wheelchair |
313 |
305 |
$6K |
| A4554 |
Disposable underpads, all sizes |
464 |
451 |
$6K |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$641.11 |