| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
11,707 |
11,182 |
$366K |
| X1939 |
|
4,146 |
4,095 |
$255K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,395 |
2,272 |
$232K |
| T5999 |
Supply, not otherwise specified |
21,871 |
19,681 |
$184K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,771 |
2,589 |
$180K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,474 |
3,296 |
$180K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,995 |
2,781 |
$141K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,476 |
3,347 |
$100K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,498 |
1,297 |
$79K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
328 |
327 |
$43K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
424 |
399 |
$30K |
| A4927 |
Gloves, non-sterile, per 100 |
2,467 |
1,169 |
$21K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
170 |
161 |
$14K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
105 |
96 |
$8K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
70 |
52 |
$7K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
90 |
87 |
$6K |
| E0570 |
Nebulizer, with compressor |
103 |
94 |
$5K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
71 |
66 |
$4K |
| K0001 |
Standard wheelchair |
108 |
82 |
$2K |
| E0244 |
Raised toilet seat |
15 |
15 |
$2K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
14 |
14 |
$1K |
| A4452 |
Tape, waterproof, per 18 square inches |
84 |
81 |
$872.75 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
69 |
61 |
$747.93 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
28 |
26 |
$163.82 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
18 |
15 |
$60.33 |