| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult disp brief/diap abv xl |
627 |
512 |
$151K |
| A4927 |
Non-sterile gloves |
1,061 |
835 |
$108K |
| A6250 |
Skin seal protect moisturizr |
1,109 |
899 |
$64K |
| T4535 |
Disposable liner/shield/pad |
975 |
770 |
$41K |
| A4246 |
Betadine/phisohex solution |
769 |
643 |
$38K |
| A4245 |
Alcohol wipes per box |
1,851 |
954 |
$38K |
| T4523 |
Adult size brief/diaper lg |
193 |
163 |
$28K |
| A7030 |
Cpap full face mask |
369 |
300 |
$19K |
| E0601 |
Cont airway pressure device |
599 |
583 |
$19K |
| A4250 |
Urine reagent strips/tablets |
182 |
147 |
$17K |
| A4500 |
Below knee surgical stocking |
75 |
67 |
$14K |
| E0562 |
Humidifier heated used w pap |
295 |
234 |
$13K |
| A6248 |
Hydrogel drsg gel filler |
137 |
114 |
$11K |
| A6266 |
Impreg gauze no h20/sal/yard |
196 |
165 |
$10K |
| A4253 |
Blood glucose/reagent strips |
181 |
147 |
$8K |
| A6260 |
Wound cleanser any type/size |
214 |
192 |
$7K |
| A7035 |
Pos airway press headgear |
363 |
287 |
$6K |
| E0470 |
Rad w/o backup non-inv intfc |
69 |
69 |
$6K |
| A4463 |
Surgical dress holder reuse |
152 |
132 |
$4K |
| A7037 |
Pos airway pressure tubing |
394 |
318 |
$4K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
57 |
48 |
$4K |
| A7036 |
Pos airway press chinstrap |
295 |
220 |
$3K |
| A7038 |
Pos airway pressure filter |
292 |
217 |
$617.54 |
| A7039 |
Filter, non disposable w pap |
86 |
82 |
$438.74 |
| A4259 |
Lancets per box |
179 |
145 |
$191.82 |
| A7031 |
Replacement facemask interfa |
18 |
18 |
$126.22 |
| A7034 |
Nasal application device |
18 |
18 |
$52.99 |
| A7032 |
Replacement nasal cushion |
39 |
39 |
$0.00 |
| A7033 |
Replacement nasal pillows |
17 |
17 |
$0.00 |