| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
1,212 |
1,141 |
$269K |
| B4154 |
Ef spec metabolic noninherit |
708 |
678 |
$172K |
| A6250 |
Skin seal protect moisturizr |
4,121 |
3,908 |
$160K |
| A4554 |
Disposable underpads |
2,459 |
2,311 |
$135K |
| A6530 |
Compression stocking bk18-30 |
2,888 |
2,706 |
$105K |
| T4544 |
Adlt disp und/pull on abv xl |
268 |
249 |
$102K |
| A4927 |
Non-sterile gloves |
2,617 |
2,496 |
$75K |
| T4535 |
Disposable liner/shield/pad |
1,448 |
1,385 |
$74K |
| T4528 |
Adult size pull-on xl |
133 |
111 |
$33K |
| B4150 |
Ef complet w/intact nutrient |
164 |
161 |
$20K |
| T4526 |
Adult size pull-on med |
109 |
93 |
$17K |
| L3206 |
Hightop w/ supp/pronator chi |
54 |
52 |
$13K |
| L3216 |
Orthoped ladies shoes dpth i |
65 |
51 |
$9K |
| A4930 |
Sterile, gloves per pair |
27 |
25 |
$3K |
| E0570 |
Nebulizer with compression |
201 |
190 |
$2K |
| A4670 |
Automatic bp monitor, dial |
28 |
27 |
$2K |
| A6533 |
Gc stocking thighlngth 18-30 |
46 |
46 |
$2K |
| A4245 |
Alcohol wipes per box |
77 |
75 |
$364.00 |
| A7005 |
Nondisposable nebulizer set |
14 |
14 |
$255.34 |
| A4617 |
Mouth piece |
15 |
15 |
$44.25 |
| A7015 |
Aerosol mask used w nebulize |
14 |
14 |
$19.18 |