| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
4,575 |
4,236 |
$174K |
| T4527 |
Adult size pull-on lg |
1,871 |
1,729 |
$164K |
| T4535 |
Disposable liner/shield/pad |
3,143 |
2,790 |
$159K |
| T4528 |
Adult size pull-on xl |
1,726 |
1,578 |
$154K |
| T4526 |
Adult size pull-on med |
1,767 |
1,634 |
$148K |
| A4927 |
Non-sterile gloves |
5,782 |
5,349 |
$44K |
| T4544 |
Adlt disp und/pull on abv xl |
483 |
447 |
$39K |
| E0240 |
Bath/shower chair |
116 |
95 |
$33K |
| T4532 |
Ped size pull-on lg |
142 |
132 |
$18K |
| E1084 |
Hemi-wheelchair detachable a |
16 |
14 |
$13K |
| A4253 |
Blood glucose/reagent strips |
242 |
224 |
$12K |
| E1390 |
Oxygen concentrator |
247 |
208 |
$10K |
| E0466 |
Home vent non-invasive inter |
14 |
12 |
$7K |
| E0601 |
Cont airway pressure device |
250 |
214 |
$7K |
| A4259 |
Lancets per box |
239 |
221 |
$3K |
| E0246 |
Transfer tub rail attachment |
43 |
28 |
$3K |
| E0260 |
Hosp bed semi-electr w/ matt |
59 |
52 |
$2K |
| K0823 |
Pwc gp 2 std cap chair |
47 |
37 |
$2K |
| E0241 |
Bath tub wall rail |
38 |
26 |
$1K |
| T4521 |
Adult size brief/diaper sm |
16 |
14 |
$957.02 |
| E0143 |
Walker folding wheeled w/o s |
14 |
13 |
$493.00 |