| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Ef complet w/intact nutrient |
1,517 |
1,464 |
$156K |
| E0603 |
Electric breast pump |
510 |
510 |
$68K |
| A4239 |
Non-adju cgm supply allow |
317 |
316 |
$58K |
| A4335 |
Incontinence supply |
685 |
659 |
$54K |
| T4528 |
Adult size pull-on xl |
265 |
254 |
$31K |
| T4535 |
Disposable liner/shield/pad |
788 |
742 |
$31K |
| T4526 |
Adult size pull-on med |
208 |
198 |
$27K |
| T4527 |
Adult size pull-on lg |
185 |
179 |
$26K |
| B4152 |
Ef calorie dense>/=1.5kcal |
160 |
160 |
$23K |
| B4035 |
Enteral feed supp pump per d |
71 |
63 |
$14K |
| T4542 |
Small disposable underpad |
330 |
316 |
$10K |
| 99605 |
|
45 |
45 |
$2K |
| A4253 |
Blood glucose/reagent strips |
29 |
28 |
$1K |
| 99607 |
|
61 |
57 |
$830.00 |
| S5199 |
Personal care item nos each |
36 |
36 |
$627.50 |
| E0240 |
Bath/shower chair |
12 |
12 |
$429.38 |
| A4452 |
Waterproof tape |
47 |
40 |
$413.27 |
| A4927 |
Non-sterile gloves |
33 |
27 |
$317.76 |
| T4541 |
Large disposable underpad |
12 |
12 |
$285.00 |