| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
26,490 |
26,300 |
$830K |
| T4544 |
Adlt disp und/pull on abv xl |
3,978 |
3,953 |
$811K |
| T4527 |
Adult size pull-on lg |
7,033 |
7,001 |
$769K |
| T4535 |
Disposable liner/shield/pad |
14,270 |
14,179 |
$555K |
| T4526 |
Adult size pull-on med |
5,298 |
5,247 |
$505K |
| T4530 |
Ped size brief/diaper lg |
1,990 |
1,966 |
$166K |
| A4335 |
Incontinence supply |
30,077 |
29,815 |
$142K |
| E0570 |
Nebulizer with compression |
3,026 |
2,948 |
$112K |
| T4528 |
Adult size pull-on xl |
412 |
412 |
$101K |
| T4534 |
Youth size pull-on |
875 |
849 |
$84K |
| T4532 |
Ped size pull-on lg |
567 |
563 |
$52K |
| 87426 |
|
1,114 |
933 |
$20K |
| A4253 |
Blood glucose/reagent strips |
1,992 |
1,967 |
$8K |
| A4670 |
Automatic bp monitor, dial |
126 |
126 |
$7K |
| E0260 |
Hosp bed semi-electr w/ matt |
411 |
411 |
$7K |
| K0001 |
Standard wheelchair |
746 |
739 |
$6K |
| T4543 |
Adult disp brief/diap abv xl |
26 |
26 |
$5K |
| T4523 |
Adult size brief/diaper lg |
38 |
38 |
$4K |
| A7003 |
Nebulizer administration set |
2,208 |
2,150 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
2,244 |
2,170 |
$2K |
| A5500 |
Diab shoe for density insert |
770 |
614 |
$962.17 |
| 87428 |
|
44 |
41 |
$955.37 |
| A4259 |
Lancets per box |
1,967 |
1,951 |
$719.02 |
| 90471 |
|
149 |
144 |
$464.45 |
| T4531 |
Ped size pull-on sm/med |
13 |
12 |
$456.00 |
| 90686 |
|
399 |
396 |
$418.33 |
| A5512 |
Multi den insert direct form |
768 |
613 |
$305.42 |
| A4245 |
Alcohol wipes per box |
93 |
92 |
$180.06 |
| Q0513 |
Disp fee inhal drugs/30 days |
100 |
100 |
$81.13 |
| J7613 |
Albuterol non-comp unit |
28 |
27 |
$79.26 |
| 0064A |
|
88 |
88 |
$18.00 |
| 0094A |
|
17 |
16 |
$0.00 |
| G0008 |
Admin influenza virus vac |
306 |
305 |
$0.00 |
| 90674 |
|
58 |
58 |
$0.00 |
| 0134A |
|
17 |
17 |
$0.00 |
| 0013A |
|
15 |
15 |
$0.00 |