| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
36,458 |
36,392 |
$1.47M |
| T4535 |
Disposable liner/shield/pad |
34,780 |
34,712 |
$1.40M |
| T4523 |
Adult size brief/diaper lg |
14,657 |
14,635 |
$1.05M |
| T4522 |
Adult size brief/diaper med |
12,850 |
12,826 |
$674K |
| T4543 |
Adult disp brief/diap abv xl |
3,346 |
3,344 |
$578K |
| T4524 |
Adult size brief/diaper xl |
8,022 |
8,000 |
$553K |
| T4537 |
Reusable underpad bed size |
8,354 |
8,342 |
$211K |
| T4521 |
Adult size brief/diaper sm |
3,192 |
3,188 |
$149K |
| A4927 |
Non-sterile gloves |
28,488 |
28,436 |
$116K |
| T4539 |
Reuse diaper/brief any size |
4,734 |
4,727 |
$110K |
| E1399 |
Durable medical equipment mi |
3,710 |
3,704 |
$58K |
| B4150 |
Ef complet w/intact nutrient |
580 |
578 |
$56K |
| A4670 |
Automatic bp monitor, dial |
520 |
520 |
$23K |
| T4540 |
Reusable underpad chair size |
1,193 |
1,191 |
$21K |
| L3030 |
Foot arch support remov prem |
190 |
155 |
$16K |
| B4154 |
Ef spec metabolic noninherit |
81 |
81 |
$15K |
| A4253 |
Blood glucose/reagent strips |
523 |
523 |
$10K |
| K0001 |
Standard wheelchair |
396 |
396 |
$10K |
| A4402 |
Lubricant per ounce |
1,783 |
1,759 |
$9K |
| L3807 |
Whfo w/o joints pre cst |
58 |
38 |
$6K |
| L3216 |
Orthoped ladies shoes dpth i |
89 |
68 |
$5K |
| E0990 |
Wheelchair elevating leg res |
193 |
193 |
$4K |
| K0739 |
Repair/svc dme non-oxygen eq |
65 |
60 |
$4K |
| A4259 |
Lancets per box |
512 |
512 |
$3K |
| A5500 |
Diab shoe for density insert |
60 |
39 |
$2K |
| A4245 |
Alcohol wipes per box |
563 |
561 |
$1K |
| E0240 |
Bath/shower chair |
24 |
24 |
$866.50 |
| A4335 |
Incontinence supply |
75 |
75 |
$79.62 |