| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
22,785 |
21,625 |
$818K |
| T4543 |
Adult disp brief/diap abv xl |
3,963 |
3,799 |
$812K |
| T4535 |
Disposable liner/shield/pad |
16,222 |
15,531 |
$720K |
| T4526 |
Adult size pull-on med |
10,061 |
9,514 |
$698K |
| T4527 |
Adult size pull-on lg |
8,950 |
8,504 |
$607K |
| A4927 |
Non-sterile gloves |
31,535 |
30,031 |
$446K |
| T4528 |
Adult size pull-on xl |
6,309 |
6,004 |
$432K |
| T2029 |
Special med equip, noswaiver |
2,128 |
1,883 |
$430K |
| T4537 |
Reusable underpad bed size |
2,358 |
2,174 |
$234K |
| T4523 |
Adult size brief/diaper lg |
1,798 |
1,684 |
$124K |
| T4540 |
Reusable underpad chair size |
1,688 |
1,567 |
$86K |
| A4670 |
Automatic bp monitor, dial |
1,419 |
1,372 |
$50K |
| A6530 |
Compression stocking bk18-30 |
937 |
346 |
$31K |
| T4524 |
Adult size brief/diaper xl |
146 |
138 |
$14K |
| T4522 |
Adult size brief/diaper med |
167 |
160 |
$12K |
| E0260 |
Hosp bed semi-electr w/ matt |
245 |
236 |
$12K |
| B4150 |
Ef complet w/intact nutrient |
71 |
66 |
$8K |
| T1999 |
Noc retail items andsupplies |
44 |
41 |
$7K |
| E0245 |
Tub stool or bench |
196 |
184 |
$6K |
| A5500 |
Diab shoe for density insert |
124 |
99 |
$4K |
| A5512 |
Multi den insert direct form |
128 |
99 |
$4K |
| K0001 |
Standard wheelchair |
144 |
138 |
$3K |
| E0570 |
Nebulizer with compression |
29 |
27 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
56 |
55 |
$2K |
| L0621 |
Sio flex pelvic/sacr pre ots |
28 |
28 |
$1K |
| L3908 |
Who cock-up nonmolde pre ots |
16 |
12 |
$548.52 |
| A7003 |
Nebulizer administration set |
228 |
112 |
$365.22 |
| E0730 |
Tens four lead |
12 |
12 |
$227.99 |
| A7015 |
Aerosol mask used w nebulize |
42 |
13 |
$51.30 |
| E0627 |
Seat lift mech, electric any |
13 |
13 |
$0.00 |