| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
7,301 |
7,270 |
$1.24M |
| A4554 |
Disposable underpads |
18,827 |
18,675 |
$668K |
| T4526 |
Adult size pull-on med |
3,827 |
3,802 |
$543K |
| T4528 |
Adult size pull-on xl |
2,031 |
2,018 |
$426K |
| T4532 |
Ped size pull-on lg |
2,298 |
2,246 |
$342K |
| T4544 |
Adlt disp und/pull on abv xl |
847 |
844 |
$248K |
| A4335 |
Incontinence supply |
19,004 |
18,824 |
$99K |
| T4535 |
Disposable liner/shield/pad |
979 |
976 |
$37K |
| K0001 |
Standard wheelchair |
2,751 |
2,675 |
$32K |
| A4253 |
Blood glucose/reagent strips |
987 |
971 |
$29K |
| E0260 |
Hosp bed semi-electr w/ matt |
945 |
888 |
$26K |
| T4523 |
Adult size brief/diaper lg |
193 |
189 |
$23K |
| L4361 |
Pneuma/vac walk boot pre ots |
160 |
153 |
$20K |
| L4360 |
Pneumat walking boot pre cst |
152 |
150 |
$19K |
| T4522 |
Adult size brief/diaper med |
140 |
138 |
$17K |
| E0570 |
Nebulizer with compression |
909 |
882 |
$16K |
| K0195 |
Elevating whlchair leg rests |
3,032 |
2,950 |
$14K |
| E0601 |
Cont airway pressure device |
192 |
192 |
$12K |
| A4259 |
Lancets per box |
665 |
657 |
$6K |
| A4927 |
Non-sterile gloves |
769 |
765 |
$6K |
| E0562 |
Humidifier heated used w pap |
257 |
257 |
$4K |
| L3908 |
Who cock-up nonmolde pre ots |
67 |
67 |
$2K |
| A4245 |
Alcohol wipes per box |
973 |
967 |
$1K |
| L1902 |
Afo ankle gauntlet pre ots |
27 |
27 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
13 |
13 |
$112.75 |
| A7003 |
Nebulizer administration set |
30 |
30 |
$43.37 |
| A7015 |
Aerosol mask used w nebulize |
30 |
30 |
$29.51 |