| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
20,208 |
19,904 |
$766K |
| T4527 |
Adult size pull-on lg |
5,794 |
5,739 |
$607K |
| B4154 |
Ef spec metabolic noninherit |
1,318 |
1,273 |
$582K |
| T4535 |
Disposable liner/shield/pad |
10,529 |
10,370 |
$383K |
| T4528 |
Adult size pull-on xl |
3,127 |
3,081 |
$380K |
| T4526 |
Adult size pull-on med |
4,284 |
4,232 |
$380K |
| E1399 |
Durable medical equipment mi |
550 |
378 |
$321K |
| T4534 |
Youth size pull-on |
1,558 |
1,483 |
$147K |
| A4335 |
Incontinence supply |
22,296 |
21,892 |
$118K |
| T4525 |
Adult size pull-on sm |
932 |
909 |
$69K |
| A4253 |
Blood glucose/reagent strips |
907 |
812 |
$32K |
| E0570 |
Nebulizer with compression |
282 |
273 |
$24K |
| B4150 |
Ef complet w/intact nutrient |
154 |
151 |
$23K |
| T4533 |
Youth size brief/diaper |
155 |
154 |
$13K |
| E0240 |
Bath/shower chair |
62 |
60 |
$9K |
| A4927 |
Non-sterile gloves |
1,062 |
1,025 |
$8K |
| T4523 |
Adult size brief/diaper lg |
77 |
76 |
$8K |
| A4259 |
Lancets per box |
846 |
801 |
$5K |
| T4522 |
Adult size brief/diaper med |
48 |
48 |
$5K |
| A7006 |
Filtered nebulizer admin set |
200 |
197 |
$1K |
| A4245 |
Alcohol wipes per box |
470 |
460 |
$902.32 |
| A7015 |
Aerosol mask used w nebulize |
202 |
197 |
$240.76 |
| E0143 |
Walker folding wheeled w/o s |
13 |
13 |
$217.29 |