| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
6,740 |
6,215 |
$683K |
| A4554 |
Disposable underpads |
14,042 |
12,684 |
$624K |
| T4528 |
Adult size pull-on xl |
5,060 |
4,633 |
$467K |
| T4526 |
Adult size pull-on med |
3,654 |
3,323 |
$331K |
| T4544 |
Adlt disp und/pull on abv xl |
2,252 |
1,987 |
$295K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,599 |
1,271 |
$173K |
| B4035 |
Enteral feed supp pump per d |
691 |
476 |
$151K |
| A4627 |
Spacer bag/reservoir |
2,853 |
2,473 |
$110K |
| B4088 |
Gastro/jejuno tube, low-pro |
882 |
782 |
$100K |
| E0570 |
Nebulizer with compression |
3,465 |
2,359 |
$94K |
| A4670 |
Automatic bp monitor, dial |
1,502 |
1,227 |
$73K |
| T4534 |
Youth size pull-on |
714 |
666 |
$72K |
| K0003 |
Lightweight wheelchair |
4,351 |
2,727 |
$67K |
| B4150 |
Ef complet w/intact nutrient |
987 |
780 |
$65K |
| A4927 |
Non-sterile gloves |
2,495 |
2,228 |
$58K |
| T4523 |
Adult size brief/diaper lg |
552 |
484 |
$50K |
| B4154 |
Ef spec metabolic noninherit |
401 |
306 |
$46K |
| E0143 |
Walker folding wheeled w/o s |
1,232 |
943 |
$40K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,624 |
1,589 |
$37K |
| A4409 |
Ost skn barr convex <=4 sq i |
170 |
123 |
$10K |
| A4614 |
Hand-held pefr meter |
438 |
401 |
$9K |
| A5063 |
Drain ostomy pouch w/flange |
328 |
226 |
$8K |
| A4253 |
Blood glucose/reagent strips |
2,298 |
1,654 |
$7K |
| T4530 |
Ped size brief/diaper lg |
44 |
38 |
$3K |
| E0973 |
W/ch access det adj armrest |
55 |
40 |
$2K |
| E0163 |
Commode chair with fixed arm |
48 |
42 |
$2K |
| E0247 |
Trans bench w/wo comm open |
18 |
15 |
$1K |
| A4520 |
Incontinence garment anytype |
15 |
15 |
$1K |
| B9998 |
Enteral supp not otherwise c |
80 |
66 |
$1K |
| E0149 |
Heavy duty wheeled walker |
77 |
49 |
$1K |
| A4259 |
Lancets per box |
1,406 |
1,058 |
$952.95 |
| E0156 |
Walker seat attachment |
167 |
127 |
$880.88 |
| A7006 |
Filtered nebulizer admin set |
44 |
42 |
$389.76 |
| E0325 |
Urinal male jug-type |
44 |
31 |
$156.09 |
| A7015 |
Aerosol mask used w nebulize |
40 |
38 |
$69.54 |
| 90686 |
|
26 |
26 |
$0.00 |
| W4211 |
|
35 |
35 |
$0.00 |
| T4535 |
Disposable liner/shield/pad |
29 |
20 |
$0.00 |