| Code | Description | Claims | Beneficiaries | Total Paid |
| A4554 |
Disposable underpads |
6,794 |
6,052 |
$295K |
| T4527 |
Adult size pull-on lg |
2,717 |
2,379 |
$239K |
| T4526 |
Adult size pull-on med |
2,551 |
2,274 |
$225K |
| T4528 |
Adult size pull-on xl |
2,251 |
2,034 |
$207K |
| T4535 |
Disposable liner/shield/pad |
3,493 |
3,012 |
$204K |
| A4253 |
Blood glucose/reagent strips |
1,783 |
1,500 |
$152K |
| A4927 |
Non-sterile gloves |
7,506 |
6,677 |
$142K |
| E1390 |
Oxygen concentrator |
970 |
853 |
$39K |
| A4259 |
Lancets per box |
1,594 |
1,345 |
$33K |
| T4522 |
Adult size brief/diaper med |
302 |
251 |
$22K |
| T4523 |
Adult size brief/diaper lg |
120 |
104 |
$9K |
| E0261 |
Hosp bed semi-electr w/o mat |
457 |
418 |
$7K |
| K0001 |
Standard wheelchair |
870 |
803 |
$6K |
| A5500 |
Diab shoe for density insert |
45 |
27 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
43 |
39 |
$2K |
| K0823 |
Pwc gp 2 std cap chair |
55 |
54 |
$2K |
| E0601 |
Cont airway pressure device |
48 |
41 |
$2K |
| E0570 |
Nebulizer with compression |
35 |
31 |
$2K |
| E0630 |
Patient lift hydraulic |
41 |
37 |
$1K |
| E0114 |
Crutch underarm pair no wood |
27 |
13 |
$567.85 |
| E0431 |
Portable gaseous 02 |
152 |
145 |
$433.89 |
| A5512 |
Multi den insert direct form |
28 |
13 |
$145.32 |
| K0195 |
Elevating whlchair leg rests |
37 |
36 |
$91.33 |
| A7038 |
Pos airway pressure filter |
12 |
12 |
$6.16 |