| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
12,143 |
11,350 |
$569K |
| T4527 |
Adult size pull-on lg |
3,863 |
3,662 |
$445K |
| B4150 |
Ef complet w/intact nutrient |
4,504 |
4,068 |
$438K |
| T4526 |
Adult size pull-on med |
3,752 |
3,587 |
$379K |
| B4154 |
Ef spec metabolic noninherit |
2,815 |
2,541 |
$359K |
| T4528 |
Adult size pull-on xl |
2,442 |
2,346 |
$278K |
| A4927 |
Non-sterile gloves |
11,549 |
10,705 |
$215K |
| T4544 |
Adlt disp und/pull on abv xl |
1,188 |
1,073 |
$180K |
| T4535 |
Disposable liner/shield/pad |
2,985 |
2,614 |
$136K |
| T2025 |
Waiver service, nos |
2,257 |
1,929 |
$91K |
| T4534 |
Youth size pull-on |
472 |
433 |
$59K |
| B4152 |
Ef calorie dense>/=1.5kcal |
187 |
166 |
$21K |
| S5165 |
Home modifications per serv |
28 |
24 |
$14K |
| T4523 |
Adult size brief/diaper lg |
114 |
105 |
$13K |
| A4928 |
Surgical mask |
453 |
400 |
$12K |
| T4522 |
Adult size brief/diaper med |
93 |
79 |
$10K |
| 0011A |
|
90 |
70 |
$4K |
| 0012A |
|
55 |
45 |
$3K |
| A4253 |
Blood glucose/reagent strips |
314 |
304 |
$2K |
| E0570 |
Nebulizer with compression |
12 |
12 |
$2K |
| A4670 |
Automatic bp monitor, dial |
26 |
25 |
$2K |
| T4525 |
Adult size pull-on sm |
13 |
13 |
$1K |
| 90686 |
|
65 |
58 |
$862.22 |
| 90471 |
|
88 |
80 |
$857.90 |
| 90674 |
|
24 |
21 |
$371.55 |
| Q0513 |
Disp fee inhal drugs/30 days |
12 |
12 |
$66.00 |
| A5120 |
Skin barrier, wipe or swab |
13 |
12 |
$65.00 |
| 91301 |
|
152 |
114 |
$0.00 |