| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
6,813 |
6,788 |
$815K |
| A4554 |
Disposable underpads |
18,013 |
17,966 |
$647K |
| T4526 |
Adult size pull-on med |
5,318 |
5,301 |
$551K |
| T4535 |
Disposable liner/shield/pad |
14,382 |
13,610 |
$502K |
| T4528 |
Adult size pull-on xl |
2,475 |
2,381 |
$337K |
| A4335 |
Incontinence supply |
21,464 |
21,364 |
$120K |
| B4154 |
Ef spec metabolic noninherit |
162 |
160 |
$91K |
| E0570 |
Nebulizer with compression |
140 |
137 |
$16K |
| A4253 |
Blood glucose/reagent strips |
656 |
655 |
$11K |
| T4523 |
Adult size brief/diaper lg |
99 |
99 |
$8K |
| A4245 |
Alcohol wipes per box |
3,479 |
3,474 |
$7K |
| A6530 |
Compression stocking bk18-30 |
12 |
12 |
$2K |
| A7006 |
Filtered nebulizer admin set |
176 |
173 |
$1K |
| A4670 |
Automatic bp monitor, dial |
15 |
15 |
$934.50 |
| A4259 |
Lancets per box |
424 |
423 |
$915.80 |
| A5512 |
Multi den insert direct form |
467 |
323 |
$556.44 |
| A5500 |
Diab shoe for density insert |
479 |
322 |
$321.17 |
| A7015 |
Aerosol mask used w nebulize |
164 |
161 |
$224.64 |
| E1399 |
Durable medical equipment mi |
20 |
13 |
$210.08 |
| L8000 |
Mastectomy bra |
18 |
12 |
$0.00 |