| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
11,707 |
11,182 |
$366K |
| X1939 |
|
4,146 |
4,095 |
$255K |
| T4534 |
Youth size pull-on |
2,395 |
2,272 |
$232K |
| T5999 |
Supply, nos |
21,871 |
19,681 |
$184K |
| T4528 |
Adult size pull-on xl |
2,771 |
2,589 |
$180K |
| T4527 |
Adult size pull-on lg |
3,474 |
3,296 |
$180K |
| T4526 |
Adult size pull-on med |
2,995 |
2,781 |
$141K |
| T4535 |
Disposable liner/shield/pad |
3,476 |
3,347 |
$100K |
| T4525 |
Adult size pull-on sm |
1,498 |
1,297 |
$79K |
| T4543 |
Adult disp brief/diap abv xl |
328 |
327 |
$43K |
| T4522 |
Adult size brief/diaper med |
424 |
399 |
$30K |
| A4927 |
Non-sterile gloves |
2,467 |
1,169 |
$21K |
| T4523 |
Adult size brief/diaper lg |
170 |
161 |
$14K |
| T4533 |
Youth size brief/diaper |
105 |
96 |
$8K |
| T4524 |
Adult size brief/diaper xl |
70 |
52 |
$7K |
| T4530 |
Ped size brief/diaper lg |
90 |
87 |
$6K |
| E0570 |
Nebulizer with compression |
103 |
94 |
$5K |
| T2028 |
Special supply, nos waiver |
71 |
66 |
$4K |
| K0001 |
Standard wheelchair |
108 |
82 |
$2K |
| E0244 |
Toilet seat raised |
15 |
15 |
$2K |
| T4521 |
Adult size brief/diaper sm |
14 |
14 |
$1K |
| A4452 |
Waterproof tape |
84 |
81 |
$872.75 |
| A6402 |
Sterile gauze <= 16 sq in |
69 |
61 |
$747.93 |
| A6446 |
Conform band s w>=3" <5"/yd |
28 |
26 |
$163.82 |
| A4253 |
Blood glucose/reagent strips |
18 |
15 |
$60.33 |