| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
24,570 |
23,431 |
$1.36M |
| T4527 |
Adult size pull-on lg |
8,799 |
8,456 |
$852K |
| T4528 |
Adult size pull-on xl |
6,990 |
6,688 |
$774K |
| T4526 |
Adult size pull-on med |
7,974 |
7,644 |
$657K |
| T4541 |
Large disposable underpad |
16,707 |
15,770 |
$646K |
| T4543 |
Adult disp brief/diap abv xl |
1,821 |
1,732 |
$294K |
| T1999 |
Noc retail items andsupplies |
1,261 |
1,185 |
$242K |
| T4537 |
Reusable underpad bed size |
1,727 |
1,719 |
$212K |
| E1390 |
Oxygen concentrator |
2,654 |
2,653 |
$186K |
| B4150 |
Ef complet w/intact nutrient |
1,328 |
1,282 |
$147K |
| B4152 |
Ef calorie dense>/=1.5kcal |
965 |
919 |
$130K |
| T4525 |
Adult size pull-on sm |
1,481 |
1,396 |
$100K |
| A4927 |
Non-sterile gloves |
5,262 |
5,054 |
$92K |
| T4544 |
Adlt disp und/pull on abv xl |
353 |
336 |
$57K |
| T4523 |
Adult size brief/diaper lg |
346 |
331 |
$37K |
| B4035 |
Enteral feed supp pump per d |
279 |
242 |
$36K |
| B4034 |
Enter feed supkit syr by day |
380 |
369 |
$29K |
| A4335 |
Incontinence supply |
1,358 |
1,298 |
$21K |
| E0431 |
Portable gaseous 02 |
1,574 |
1,574 |
$17K |
| E1399 |
Durable medical equipment mi |
207 |
203 |
$16K |
| K0001 |
Standard wheelchair |
524 |
524 |
$13K |
| S5161 |
Emer rspns sys serv permonth |
333 |
332 |
$12K |
| E0562 |
Humidifier heated used w pap |
423 |
421 |
$10K |
| E0260 |
Hosp bed semi-electr w/ matt |
202 |
202 |
$7K |
| E0240 |
Bath/shower chair |
53 |
53 |
$4K |
| E0601 |
Cont airway pressure device |
41 |
41 |
$3K |
| T4524 |
Adult size brief/diaper xl |
12 |
12 |
$2K |
| A7031 |
Replacement facemask interfa |
158 |
158 |
$1K |
| A7038 |
Pos airway pressure filter |
544 |
544 |
$854.42 |
| E0570 |
Nebulizer with compression |
12 |
12 |
$567.60 |
| A7030 |
Cpap full face mask |
12 |
12 |
$522.90 |