| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4521 |
Adult size brief/diaper sm |
2,008 |
1,821 |
$240K |
| T4533 |
Youth size brief/diaper |
1,045 |
841 |
$115K |
| T4522 |
Adult size brief/diaper med |
949 |
832 |
$111K |
| A4927 |
Non-sterile gloves |
4,410 |
4,064 |
$97K |
| T4530 |
Ped size brief/diaper lg |
577 |
491 |
$41K |
| E0570 |
Nebulizer with compression |
1,108 |
1,033 |
$39K |
| E1390 |
Oxygen concentrator |
991 |
894 |
$37K |
| A4253 |
Blood glucose/reagent strips |
883 |
814 |
$20K |
| E0431 |
Portable gaseous 02 |
817 |
741 |
$7K |
| E0260 |
Hosp bed semi-electr w/ matt |
142 |
130 |
$4K |
| A7005 |
Nondisposable nebulizer set |
180 |
177 |
$3K |
| A4520 |
Incontinence garment anytype |
142 |
137 |
$2K |
| K0001 |
Standard wheelchair |
526 |
486 |
$2K |
| T4523 |
Adult size brief/diaper lg |
15 |
12 |
$889.92 |
| A4259 |
Lancets per box |
291 |
260 |
$869.71 |
| A7000 |
Disposable canister for pump |
12 |
12 |
$248.40 |
| A4357 |
Bedside drainage bag |
15 |
12 |
$139.68 |
| A5120 |
Skin barrier, wipe or swab |
13 |
12 |
$95.45 |
| A7015 |
Aerosol mask used w nebulize |
31 |
31 |
$40.61 |
| A7002 |
Tubing used w suction pump |
14 |
14 |
$26.10 |