| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
5,800 |
5,768 |
$682K |
| A4554 |
Disposable underpads |
17,087 |
17,010 |
$609K |
| T4535 |
Disposable liner/shield/pad |
9,671 |
9,468 |
$386K |
| T4526 |
Adult size pull-on med |
3,509 |
3,492 |
$368K |
| T4528 |
Adult size pull-on xl |
1,542 |
1,534 |
$228K |
| A4335 |
Incontinence supply |
19,429 |
19,317 |
$105K |
| E0570 |
Nebulizer with compression |
1,443 |
1,437 |
$72K |
| T4523 |
Adult size brief/diaper lg |
222 |
222 |
$21K |
| E0260 |
Hosp bed semi-electr w/ matt |
838 |
837 |
$19K |
| K0001 |
Standard wheelchair |
1,590 |
1,576 |
$18K |
| T4524 |
Adult size brief/diaper xl |
128 |
128 |
$17K |
| K0195 |
Elevating whlchair leg rests |
1,975 |
1,948 |
$10K |
| K0004 |
High strength ltwt whlchr |
206 |
206 |
$6K |
| A4670 |
Automatic bp monitor, dial |
89 |
89 |
$5K |
| T4522 |
Adult size brief/diaper med |
26 |
26 |
$3K |
| A4253 |
Blood glucose/reagent strips |
262 |
262 |
$2K |
| A7005 |
Nondisposable nebulizer set |
112 |
112 |
$2K |
| A7003 |
Nebulizer administration set |
419 |
417 |
$701.35 |
| A7015 |
Aerosol mask used w nebulize |
404 |
398 |
$448.33 |
| E0143 |
Walker folding wheeled w/o s |
12 |
12 |
$378.81 |
| A5500 |
Diab shoe for density insert |
275 |
170 |
$269.10 |
| A4259 |
Lancets per box |
260 |
260 |
$186.50 |
| A5512 |
Multi den insert direct form |
273 |
167 |
$77.40 |
| 0012A |
|
113 |
113 |
$0.00 |
| 0011A |
|
123 |
123 |
$0.00 |