| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4930 |
Sterile, gloves per pair |
8,295 |
6,203 |
$1.28M |
| A4554 |
Disposable underpads |
10,719 |
8,722 |
$601K |
| T4527 |
Adult size pull-on lg |
2,676 |
2,196 |
$505K |
| T4526 |
Adult size pull-on med |
2,757 |
2,320 |
$456K |
| A6250 |
Skin seal protect moisturizr |
11,702 |
8,854 |
$350K |
| T4528 |
Adult size pull-on xl |
1,624 |
1,403 |
$317K |
| T4535 |
Disposable liner/shield/pad |
3,481 |
2,876 |
$254K |
| T4544 |
Adlt disp und/pull on abv xl |
428 |
421 |
$157K |
| A4927 |
Non-sterile gloves |
4,445 |
3,619 |
$122K |
| E0143 |
Walker folding wheeled w/o s |
1,719 |
1,472 |
$70K |
| K0001 |
Standard wheelchair |
1,840 |
1,456 |
$68K |
| E0245 |
Tub stool or bench |
1,068 |
972 |
$50K |
| E1390 |
Oxygen concentrator |
903 |
643 |
$41K |
| E2402 |
Neg press wound therapy pump |
396 |
369 |
$41K |
| A5120 |
Skin barrier, wipe or swab |
2,090 |
1,490 |
$13K |
| T4534 |
Youth size pull-on |
49 |
48 |
$12K |
| E0990 |
Wheelchair elevating leg res |
173 |
150 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
457 |
391 |
$9K |
| A4670 |
Automatic bp monitor, dial |
78 |
37 |
$5K |
| E0431 |
Portable gaseous 02 |
342 |
270 |
$4K |
| B4152 |
Ef calorie dense>/=1.5kcal |
32 |
24 |
$2K |
| K0003 |
Lightweight wheelchair |
71 |
38 |
$2K |
| A6550 |
Neg pres wound ther drsg set |
30 |
24 |
$1K |
| K0195 |
Elevating whlchair leg rests |
636 |
469 |
$1K |
| E0247 |
Trans bench w/wo comm open |
15 |
12 |
$1K |
| E0149 |
Heavy duty wheeled walker |
82 |
64 |
$796.59 |
| E0156 |
Walker seat attachment |
81 |
53 |
$652.97 |
| E0730 |
Tens four lead |
58 |
39 |
$194.80 |
| A4245 |
Alcohol wipes per box |
25 |
14 |
$169.15 |
| A7000 |
Disposable canister for pump |
15 |
12 |
$0.53 |
| A9286 |
Any hygienic item, device |
64 |
64 |
$0.00 |