| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
9,237 |
9,224 |
$350K |
| T4523 |
Adult size brief/diaper lg |
3,463 |
3,459 |
$279K |
| T4535 |
Disposable liner/shield/pad |
9,328 |
9,321 |
$273K |
| E1392 |
Portable oxygen concentrator |
1,296 |
1,296 |
$251K |
| T4524 |
Adult size brief/diaper xl |
2,543 |
2,539 |
$223K |
| T4522 |
Adult size brief/diaper med |
2,503 |
2,495 |
$154K |
| T4539 |
Reuse diaper/brief any size |
4,548 |
4,546 |
$105K |
| T4537 |
Reusable underpad bed size |
2,857 |
2,853 |
$78K |
| B4150 |
Ef complet w/intact nutrient |
524 |
513 |
$59K |
| K0003 |
Lightweight wheelchair |
324 |
322 |
$50K |
| E0143 |
Walker folding wheeled w/o s |
327 |
326 |
$22K |
| L0648 |
Lso sag r an/pos pnl pre ots |
47 |
47 |
$21K |
| B4035 |
Enteral feed supp pump per d |
165 |
163 |
$20K |
| A5057 |
1 pc ost pou w built-in conv |
64 |
62 |
$17K |
| E1390 |
Oxygen concentrator |
191 |
191 |
$13K |
| A4406 |
Pectin based ostomy paste |
314 |
312 |
$10K |
| L3001 |
Foot insert remov molded spe |
98 |
64 |
$9K |
| E0156 |
Walker seat attachment |
477 |
472 |
$8K |
| A6402 |
Sterile gauze <= 16 sq in |
889 |
872 |
$8K |
| A4927 |
Non-sterile gloves |
1,832 |
1,815 |
$5K |
| A4394 |
Ostomy pouch liq deodorant |
276 |
270 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
513 |
506 |
$5K |
| L3030 |
Foot arch support remov prem |
79 |
55 |
$5K |
| L3410 |
Shoe metatarsal bar between |
84 |
52 |
$4K |
| B4034 |
Enter feed supkit syr by day |
96 |
93 |
$4K |
| E0974 |
W/ch access anti-rollback |
54 |
53 |
$4K |
| E0241 |
Bath tub wall rail |
76 |
73 |
$4K |
| B4152 |
Ef calorie dense>/=1.5kcal |
26 |
26 |
$3K |
| E0431 |
Portable gaseous 02 |
191 |
191 |
$3K |
| A4456 |
Adhesive remover, wipes |
279 |
276 |
$3K |
| L3340 |
Shoe wedge sach |
86 |
52 |
$3K |
| A4216 |
Sterile water/saline, 10 ml |
61 |
61 |
$3K |
| E0261 |
Hosp bed semi-electr w/o mat |
12 |
12 |
$3K |
| E0990 |
Wheelchair elevating leg res |
21 |
15 |
$3K |
| L3390 |
Shoe outflare wedge |
87 |
52 |
$2K |
| T4540 |
Reusable underpad chair size |
161 |
161 |
$2K |
| E0163 |
Commode chair with fixed arm |
24 |
24 |
$2K |
| A5500 |
Diab shoe for density insert |
43 |
27 |
$2K |
| A6539 |
Gc stocking waistlngth 18-30 |
21 |
16 |
$2K |
| E0240 |
Bath/shower chair |
54 |
54 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
41 |
41 |
$2K |
| L3217 |
Ladies shoes hightop depth i |
18 |
13 |
$1K |
| A4629 |
Tracheostomy care kit |
12 |
12 |
$1K |
| E0247 |
Trans bench w/wo comm open |
13 |
13 |
$994.83 |
| A5512 |
Multi den insert direct form |
44 |
26 |
$872.40 |
| E0246 |
Transfer tub rail attachment |
15 |
14 |
$687.74 |
| K0195 |
Elevating whlchair leg rests |
202 |
202 |
$325.94 |
| A4450 |
Non-waterproof tape |
12 |
12 |
$118.53 |
| A4322 |
Irrigation syringe |
27 |
24 |
$104.38 |
| A4371 |
Skin barrier powder per oz |
12 |
12 |
$53.22 |