| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9999 |
Dme supply or accessory, nos |
334,757 |
72,998 |
$6.13M |
| B4154 |
Ef spec metabolic noninherit |
32,727 |
8,375 |
$3.03M |
| B4150 |
Ef complet w/intact nutrient |
42,733 |
11,095 |
$3.02M |
| B4152 |
Ef calorie dense>/=1.5kcal |
15,915 |
3,904 |
$1.42M |
| T4535 |
Disposable liner/shield/pad |
21,362 |
19,294 |
$1.14M |
| A4554 |
Disposable underpads |
13,663 |
12,932 |
$832K |
| A4335 |
Incontinence supply |
40,500 |
38,324 |
$550K |
| A4927 |
Non-sterile gloves |
25,446 |
22,511 |
$426K |
| T4527 |
Adult size pull-on lg |
6,200 |
5,973 |
$355K |
| A6250 |
Skin seal protect moisturizr |
20,799 |
16,430 |
$225K |
| E0143 |
Walker folding wheeled w/o s |
2,617 |
2,571 |
$219K |
| T4528 |
Adult size pull-on xl |
2,780 |
2,652 |
$166K |
| E0240 |
Bath/shower chair |
2,760 |
2,748 |
$108K |
| T4540 |
Reusable underpad chair size |
2,791 |
2,706 |
$99K |
| T4525 |
Adult size pull-on sm |
1,706 |
1,599 |
$90K |
| E0244 |
Toilet seat raised |
1,531 |
1,514 |
$73K |
| A9270 |
Non-covered item or service |
8,851 |
7,927 |
$73K |
| B4102 |
Ef adult fluids and electro |
572 |
234 |
$65K |
| A4466 |
Elastic garment/covering |
2,631 |
2,417 |
$57K |
| A9900 |
Supply/accessory/service |
2,077 |
2,066 |
$56K |
| E0245 |
Tub stool or bench |
1,487 |
1,477 |
$56K |
| E0241 |
Bath tub wall rail |
2,410 |
1,979 |
$51K |
| A6549 |
Grad com garm noc day use |
2,277 |
1,967 |
$49K |
| L0625 |
Lo flex l1-below l5 pre ots |
1,879 |
1,840 |
$49K |
| A6530 |
Compression stocking bk18-30 |
1,218 |
1,078 |
$41K |
| E0247 |
Trans bench w/wo comm open |
321 |
321 |
$24K |
| A4245 |
Alcohol wipes per box |
3,434 |
3,428 |
$22K |
| K0002 |
Stnd hemi (low seat) whlchr |
148 |
148 |
$21K |
| E0100 |
Cane adjust/fixed with tip |
1,846 |
1,822 |
$20K |
| T4524 |
Adult size brief/diaper xl |
224 |
206 |
$20K |
| E0163 |
Commode chair with fixed arm |
451 |
450 |
$18K |
| A6413 |
Adhesive bandage, first-aid |
1,708 |
1,704 |
$14K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
1,318 |
1,317 |
$13K |
| E0149 |
Heavy duty wheeled walker |
137 |
136 |
$12K |
| A4467 |
Belt strap sleev grmnt cover |
733 |
733 |
$11K |
| E0243 |
Toilet rail |
202 |
201 |
$8K |
| E0105 |
Cane adjust/fixed quad/3 pro |
374 |
371 |
$8K |
| A6402 |
Sterile gauze <= 16 sq in |
833 |
825 |
$4K |
| A4452 |
Waterproof tape |
536 |
536 |
$4K |
| L3923 |
Hfo without joints pre cst |
312 |
312 |
$3K |
| A6452 |
High compres band w>=3"<5"yd |
998 |
781 |
$3K |
| A4649 |
Surgical supplies |
876 |
747 |
$3K |
| A6446 |
Conform band s w>=3" <5"/yd |
477 |
475 |
$2K |
| E0325 |
Urinal male jug-type |
147 |
145 |
$620.00 |