| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
9,189 |
7,905 |
$713K |
| A4554 |
Disposable underpads |
12,204 |
11,214 |
$596K |
| T4527 |
Adult size pull-on lg |
4,822 |
4,484 |
$580K |
| B4150 |
Ef complet w/intact nutrient |
6,182 |
4,616 |
$497K |
| B4154 |
Ef spec metabolic noninherit |
4,104 |
2,832 |
$455K |
| T4528 |
Adult size pull-on xl |
3,603 |
3,393 |
$399K |
| T4526 |
Adult size pull-on med |
2,545 |
2,370 |
$304K |
| T4532 |
Ped size pull-on lg |
1,287 |
1,082 |
$157K |
| T4535 |
Disposable liner/shield/pad |
4,323 |
3,185 |
$134K |
| T4525 |
Adult size pull-on sm |
1,054 |
908 |
$107K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,176 |
844 |
$102K |
| T4544 |
Adlt disp und/pull on abv xl |
543 |
528 |
$88K |
| A4927 |
Non-sterile gloves |
4,159 |
3,809 |
$81K |
| A4670 |
Automatic bp monitor, dial |
1,286 |
1,063 |
$66K |
| E0570 |
Nebulizer with compression |
1,010 |
785 |
$64K |
| T2025 |
Waiver service, nos |
2,108 |
1,215 |
$60K |
| T4524 |
Adult size brief/diaper xl |
405 |
386 |
$53K |
| T4531 |
Ped size pull-on sm/med |
447 |
391 |
$47K |
| E1390 |
Oxygen concentrator |
448 |
378 |
$37K |
| T4534 |
Youth size pull-on |
256 |
217 |
$31K |
| T4523 |
Adult size brief/diaper lg |
245 |
238 |
$29K |
| B4103 |
Ef ped fluid and electrolyte |
272 |
222 |
$19K |
| A4335 |
Incontinence supply |
1,644 |
1,548 |
$12K |
| A7005 |
Nondisposable nebulizer set |
493 |
454 |
$11K |
| K0738 |
Portable gas oxygen system |
318 |
274 |
$7K |
| E0202 |
Phototherapy light w/ photom |
171 |
81 |
$6K |
| S5161 |
Emer rspns sys serv permonth |
246 |
161 |
$4K |
| K0001 |
Standard wheelchair |
520 |
304 |
$4K |
| A4627 |
Spacer bag/reservoir |
25 |
22 |
$837.89 |
| A7015 |
Aerosol mask used w nebulize |
497 |
456 |
$815.39 |
| A7003 |
Nebulizer administration set |
425 |
399 |
$18.49 |