| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
9,515 |
9,381 |
$486K |
| T4523 |
Adult size brief/diaper lg |
3,070 |
3,039 |
$256K |
| T4522 |
Adult size brief/diaper med |
2,457 |
2,411 |
$139K |
| A4335 |
Incontinence supply |
6,414 |
6,275 |
$126K |
| T4524 |
Adult size brief/diaper xl |
1,466 |
1,458 |
$117K |
| T4535 |
Disposable liner/shield/pad |
4,974 |
4,965 |
$105K |
| B4150 |
Ef complet w/intact nutrient |
905 |
904 |
$85K |
| E1390 |
Oxygen concentrator |
762 |
754 |
$83K |
| A4927 |
Non-sterile gloves |
10,773 |
10,718 |
$60K |
| T4537 |
Reusable underpad bed size |
2,641 |
2,629 |
$51K |
| A6250 |
Skin seal protect moisturizr |
4,257 |
4,209 |
$29K |
| E0431 |
Portable gaseous 02 |
723 |
718 |
$17K |
| T4543 |
Adult disp brief/diap abv xl |
97 |
97 |
$16K |
| E0601 |
Cont airway pressure device |
210 |
208 |
$12K |
| E0445 |
Oximeter non-invasive |
72 |
70 |
$11K |
| A4253 |
Blood glucose/reagent strips |
275 |
275 |
$10K |
| A5120 |
Skin barrier, wipe or swab |
482 |
482 |
$9K |
| T4521 |
Adult size brief/diaper sm |
172 |
169 |
$9K |
| A4402 |
Lubricant per ounce |
720 |
718 |
$8K |
| A4629 |
Tracheostomy care kit |
78 |
76 |
$7K |
| A4217 |
Sterile water/saline, 500 ml |
531 |
496 |
$5K |
| B4154 |
Ef spec metabolic noninherit |
26 |
26 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
302 |
281 |
$4K |
| A4351 |
Straight tip urine catheter |
25 |
25 |
$3K |
| A4624 |
Tracheal suction tube |
14 |
14 |
$3K |
| A7000 |
Disposable canister for pump |
136 |
133 |
$2K |
| A4259 |
Lancets per box |
263 |
263 |
$1K |
| A4357 |
Bedside drainage bag |
13 |
13 |
$792.11 |
| A4245 |
Alcohol wipes per box |
467 |
467 |
$628.78 |
| A7002 |
Tubing used w suction pump |
118 |
104 |
$568.02 |
| A9999 |
Dme supply or accessory, nos |
160 |
151 |
$405.92 |
| A4358 |
Urinary leg or abdomen bag |
12 |
12 |
$255.99 |