| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
2,600 |
2,581 |
$352K |
| A4554 |
Disposable underpads |
7,936 |
7,859 |
$285K |
| T4528 |
Adult size pull-on xl |
1,628 |
1,602 |
$242K |
| T4535 |
Disposable liner/shield/pad |
3,999 |
3,967 |
$171K |
| T4526 |
Adult size pull-on med |
1,564 |
1,548 |
$164K |
| A4335 |
Incontinence supply |
8,587 |
8,487 |
$46K |
| E0745 |
Neuromuscular stim for shock |
529 |
522 |
$9K |
| E0635 |
Patient lift electric |
168 |
167 |
$4K |
| A4670 |
Automatic bp monitor, dial |
36 |
36 |
$2K |
| A4253 |
Blood glucose/reagent strips |
452 |
431 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
37 |
37 |
$528.57 |
| A4927 |
Non-sterile gloves |
57 |
57 |
$426.79 |
| K0001 |
Standard wheelchair |
77 |
76 |
$315.90 |
| A4259 |
Lancets per box |
392 |
377 |
$114.07 |
| A5500 |
Diab shoe for density insert |
218 |
144 |
$44.88 |
| E0570 |
Nebulizer with compression |
80 |
79 |
$30.24 |
| A7005 |
Nondisposable nebulizer set |
13 |
12 |
$28.47 |
| A7015 |
Aerosol mask used w nebulize |
15 |
13 |
$3.08 |
| A5512 |
Multi den insert direct form |
218 |
143 |
$0.00 |