| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
17,023 |
16,658 |
$1.37M |
| T4523 |
Adult size brief/diaper lg |
6,559 |
6,404 |
$959K |
| T4522 |
Adult size brief/diaper med |
6,114 |
5,974 |
$687K |
| T4524 |
Adult size brief/diaper xl |
4,036 |
3,934 |
$617K |
| T4537 |
Reusable underpad bed size |
13,507 |
13,230 |
$457K |
| T4539 |
Reuse diaper/brief any size |
6,403 |
6,158 |
$206K |
| T4540 |
Reusable underpad chair size |
10,761 |
10,594 |
$192K |
| E0570 |
Nebulizer with compression |
2,175 |
2,173 |
$177K |
| T4535 |
Disposable liner/shield/pad |
4,117 |
4,011 |
$101K |
| A4927 |
Non-sterile gloves |
17,399 |
17,027 |
$78K |
| T4521 |
Adult size brief/diaper sm |
230 |
222 |
$21K |
| T4533 |
Youth size brief/diaper |
184 |
184 |
$18K |
| A7005 |
Nondisposable nebulizer set |
1,216 |
1,213 |
$16K |
| L3030 |
Foot arch support remov prem |
324 |
163 |
$15K |
| B4150 |
Ef complet w/intact nutrient |
51 |
50 |
$9K |
| T4530 |
Ped size brief/diaper lg |
95 |
93 |
$7K |
| A4351 |
Straight tip urine catheter |
37 |
37 |
$5K |
| A7015 |
Aerosol mask used w nebulize |
1,989 |
1,981 |
$2K |
| S8101 |
Spacer with mask |
53 |
53 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
113 |
107 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
24 |
13 |
$689.44 |