| Code | Description | Claims | Beneficiaries | Total Paid |
| T4528 |
Adult size pull-on xl |
1,918 |
1,848 |
$146K |
| E0570 |
Nebulizer with compression |
3,120 |
2,857 |
$86K |
| T4527 |
Adult size pull-on lg |
1,113 |
1,068 |
$69K |
| A4520 |
Incontinence garment anytype |
2,278 |
2,035 |
$68K |
| T4526 |
Adult size pull-on med |
972 |
918 |
$61K |
| A4239 |
Non-adju cgm supply allow |
242 |
227 |
$56K |
| T4525 |
Adult size pull-on sm |
763 |
703 |
$51K |
| A4253 |
Blood glucose/reagent strips |
2,373 |
2,083 |
$47K |
| A4215 |
Sterile needle |
1,517 |
1,403 |
$30K |
| E0601 |
Cont airway pressure device |
573 |
512 |
$24K |
| A4554 |
Disposable underpads |
810 |
772 |
$14K |
| 91320 |
|
112 |
107 |
$12K |
| T4535 |
Disposable liner/shield/pad |
611 |
576 |
$12K |
| 0002A |
|
283 |
277 |
$11K |
| 0001A |
|
314 |
309 |
$10K |
| A6530 |
Compression stocking bk18-30 |
136 |
65 |
$5K |
| 0004A |
|
142 |
136 |
$5K |
| G0008 |
Admin influenza virus vac |
315 |
297 |
$5K |
| K0553 |
Ther cgm supply allowance |
27 |
24 |
$5K |
| A4259 |
Lancets per box |
1,139 |
1,055 |
$4K |
| 90674 |
|
184 |
172 |
$4K |
| 90480 |
|
116 |
111 |
$3K |
| A7003 |
Nebulizer administration set |
1,657 |
1,565 |
$3K |
| 0124A |
|
81 |
75 |
$3K |
| A4351 |
Straight tip urine catheter |
27 |
25 |
$2K |
| A4357 |
Bedside drainage bag |
354 |
336 |
$2K |
| A4670 |
Automatic bp monitor, dial |
47 |
47 |
$2K |
| 90686 |
|
105 |
99 |
$2K |
| A4385 |
Ost skn barrier sld ext wear |
39 |
36 |
$2K |
| A7038 |
Pos airway pressure filter |
422 |
406 |
$2K |
| 0031A |
|
40 |
32 |
$1K |
| A4206 |
1 cc sterile syringe&needle |
43 |
42 |
$906.00 |
| 0134A |
|
23 |
23 |
$880.00 |
| L0621 |
Sio flex pelvic/sacr pre ots |
15 |
12 |
$845.57 |
| A4627 |
Spacer bag/reservoir |
53 |
51 |
$814.02 |
| T4522 |
Adult size brief/diaper med |
13 |
12 |
$735.36 |
| T4531 |
Ped size pull-on sm/med |
12 |
12 |
$640.56 |
| 0012A |
|
19 |
19 |
$567.46 |
| 90661 |
|
22 |
22 |
$556.58 |
| E0607 |
Blood glucose monitor home |
19 |
15 |
$493.71 |
| A7037 |
Pos airway pressure tubing |
68 |
66 |
$478.06 |
| A6402 |
Sterile gauze <= 16 sq in |
58 |
49 |
$421.94 |
| 0011A |
|
21 |
21 |
$421.04 |
| A7005 |
Nondisposable nebulizer set |
27 |
26 |
$410.73 |
| A7035 |
Pos airway press headgear |
12 |
12 |
$387.28 |
| 90471 |
|
64 |
54 |
$178.15 |
| A4258 |
Lancet device each |
57 |
44 |
$80.11 |
| A7015 |
Aerosol mask used w nebulize |
12 |
12 |
$16.16 |
| 91300 |
|
844 |
692 |
$0.00 |
| 91313 |
|
13 |
13 |
$0.00 |
| 91312 |
|
39 |
36 |
$0.00 |
| A9270 |
Non-covered item or service |
78 |
75 |
$0.00 |
| 91301 |
|
38 |
36 |
$0.00 |
| 91303 |
|
38 |
32 |
$0.00 |
| 91305 |
|
18 |
15 |
$0.00 |