| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
8,567 |
7,629 |
$449K |
| T4526 |
Adult size pull-on med |
2,963 |
2,691 |
$334K |
| T4527 |
Adult size pull-on lg |
2,475 |
2,326 |
$302K |
| T4532 |
Ped size pull-on lg |
1,743 |
1,487 |
$227K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,214 |
1,077 |
$149K |
| T4528 |
Adult size pull-on xl |
962 |
894 |
$127K |
| T4523 |
Adult size brief/diaper lg |
841 |
773 |
$93K |
| T4522 |
Adult size brief/diaper med |
704 |
639 |
$75K |
| B4152 |
Ef calorie dense>/=1.5kcal |
607 |
445 |
$69K |
| A4927 |
Non-sterile gloves |
3,589 |
3,246 |
$63K |
| E0601 |
Cont airway pressure device |
2,757 |
1,834 |
$62K |
| B4035 |
Enteral feed supp pump per d |
258 |
205 |
$60K |
| T4525 |
Adult size pull-on sm |
619 |
471 |
$54K |
| T4531 |
Ped size pull-on sm/med |
370 |
337 |
$39K |
| A4335 |
Incontinence supply |
2,036 |
1,945 |
$16K |
| T4530 |
Ped size brief/diaper lg |
103 |
101 |
$9K |
| A7037 |
Pos airway pressure tubing |
927 |
631 |
$8K |
| A7030 |
Cpap full face mask |
207 |
138 |
$8K |
| A4520 |
Incontinence garment anytype |
224 |
121 |
$7K |
| E0570 |
Nebulizer with compression |
318 |
210 |
$6K |
| A7035 |
Pos airway press headgear |
403 |
284 |
$4K |
| B4034 |
Enter feed supkit syr by day |
34 |
24 |
$2K |
| A7038 |
Pos airway pressure filter |
1,200 |
803 |
$2K |
| E1028 |
W/c manual swingaway |
214 |
105 |
$2K |
| E0973 |
W/ch access det adj armrest |
322 |
121 |
$2K |
| T4534 |
Youth size pull-on |
13 |
12 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
22 |
12 |
$1K |
| E1390 |
Oxygen concentrator |
41 |
24 |
$1K |
| A7034 |
Nasal application device |
20 |
12 |
$415.35 |
| B9998 |
Enteral supp not otherwise c |
14 |
12 |
$91.70 |