| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2510 |
Sgd w multi methods msg/accs |
1,686 |
1,593 |
$11.83M |
| T4527 |
Adult size pull-on lg |
9,183 |
8,591 |
$1.58M |
| T4528 |
Adult size pull-on xl |
6,389 |
6,010 |
$1.43M |
| T4526 |
Adult size pull-on med |
6,773 |
6,431 |
$1.13M |
| T4543 |
Adult disp brief/diap abv xl |
2,592 |
2,266 |
$1.01M |
| A4554 |
Disposable underpads |
18,600 |
16,488 |
$977K |
| T4534 |
Youth size pull-on |
2,468 |
2,426 |
$896K |
| T4524 |
Adult size brief/diaper xl |
3,734 |
3,375 |
$793K |
| T4523 |
Adult size brief/diaper lg |
3,859 |
3,554 |
$684K |
| T4544 |
Adlt disp und/pull on abv xl |
2,423 |
2,246 |
$643K |
| A4520 |
Incontinence garment anytype |
5,295 |
4,908 |
$551K |
| T4522 |
Adult size brief/diaper med |
2,321 |
2,173 |
$387K |
| T4525 |
Adult size pull-on sm |
1,198 |
1,132 |
$230K |
| E0240 |
Bath/shower chair |
387 |
380 |
$218K |
| E2599 |
Sgd accessory noc |
181 |
164 |
$202K |
| E2402 |
Neg press wound therapy pump |
445 |
328 |
$201K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,127 |
920 |
$174K |
| T4530 |
Ped size brief/diaper lg |
484 |
465 |
$162K |
| E0676 |
Inter limb compress dev nos |
144 |
125 |
$149K |
| T4521 |
Adult size brief/diaper sm |
572 |
545 |
$140K |
| A4239 |
Non-adju cgm supply allow |
716 |
625 |
$140K |
| T4529 |
Ped size brief/diaper sm/med |
355 |
349 |
$99K |
| E1399 |
Durable medical equipment mi |
92 |
83 |
$94K |
| A4351 |
Straight tip urine catheter |
436 |
390 |
$87K |
| A4927 |
Non-sterile gloves |
8,535 |
7,680 |
$76K |
| A4353 |
Intermittent urinary cath |
37 |
37 |
$49K |
| A6530 |
Compression stocking bk18-30 |
906 |
689 |
$43K |
| A6550 |
Neg pres wound ther drsg set |
374 |
267 |
$35K |
| K0001 |
Standard wheelchair |
417 |
309 |
$29K |
| A4670 |
Automatic bp monitor, dial |
343 |
333 |
$27K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
48 |
45 |
$26K |
| A4357 |
Bedside drainage bag |
1,355 |
1,175 |
$26K |
| A4553 |
Nondisp underpads, all sizes |
476 |
461 |
$24K |
| T4531 |
Ped size pull-on sm/med |
114 |
114 |
$24K |
| A6250 |
Skin seal protect moisturizr |
549 |
526 |
$24K |
| K0553 |
Ther cgm supply allowance |
115 |
113 |
$23K |
| E0630 |
Patient lift hydraulic |
155 |
129 |
$22K |
| E0603 |
Electric breast pump |
57 |
57 |
$17K |
| T4533 |
Youth size brief/diaper |
52 |
51 |
$13K |
| A6260 |
Wound cleanser any type/size |
689 |
580 |
$12K |
| E0143 |
Walker folding wheeled w/o s |
355 |
321 |
$11K |
| A4358 |
Urinary leg or abdomen bag |
840 |
721 |
$10K |
| A4311 |
Catheter w/o bag 2-way latex |
345 |
310 |
$7K |
| A7000 |
Disposable canister for pump |
369 |
265 |
$6K |
| A4349 |
Disposable male external cat |
147 |
127 |
$5K |
| E1390 |
Oxygen concentrator |
110 |
97 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
537 |
472 |
$4K |
| E0570 |
Nebulizer with compression |
27 |
27 |
$4K |
| E0156 |
Walker seat attachment |
233 |
222 |
$3K |
| T4532 |
Ped size pull-on lg |
14 |
13 |
$3K |
| A4310 |
Insert tray w/o bag/cath |
218 |
159 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
54 |
48 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
118 |
105 |
$2K |
| A4335 |
Incontinence supply |
385 |
374 |
$2K |
| E0325 |
Urinal male jug-type |
209 |
177 |
$1K |
| A4338 |
Indwelling catheter latex |
141 |
85 |
$1K |
| A4930 |
Sterile, gloves per pair |
38 |
37 |
$1K |
| A5120 |
Skin barrier, wipe or swab |
208 |
172 |
$1K |
| K0738 |
Portable gas oxygen system |
47 |
45 |
$658.00 |
| E0971 |
Wheelchair anti-tipping devi |
51 |
24 |
$557.31 |
| A4320 |
Irrigation tray |
65 |
62 |
$546.96 |
| A4450 |
Non-waterproof tape |
263 |
239 |
$379.08 |
| E2601 |
Gen w/c cushion wdth < 22 in |
28 |
13 |
$181.32 |
| A4452 |
Waterproof tape |
12 |
12 |
$92.07 |
| A7004 |
Disposable nebulizer sml vol |
49 |
48 |
$70.96 |