| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
7,619 |
6,551 |
$484K |
| T4524 |
Adult size brief/diaper xl |
3,843 |
3,453 |
$419K |
| T4539 |
Reuse diaper/brief any size |
7,784 |
6,657 |
$237K |
| T4535 |
Disposable liner/shield/pad |
6,797 |
6,212 |
$220K |
| T4523 |
Adult size brief/diaper lg |
1,717 |
1,647 |
$175K |
| T4537 |
Reusable underpad bed size |
3,233 |
3,013 |
$116K |
| L3216 |
Orthoped ladies shoes dpth i |
1,251 |
624 |
$54K |
| L3030 |
Foot arch support remov prem |
730 |
362 |
$47K |
| T4540 |
Reusable underpad chair size |
2,302 |
2,129 |
$47K |
| L3221 |
Orthopedic mens shoes dpth i |
578 |
285 |
$29K |
| L3060 |
Foot arch supp longitud/meta |
542 |
266 |
$27K |
| A5120 |
Skin barrier, wipe or swab |
1,832 |
1,606 |
$18K |
| A4927 |
Non-sterile gloves |
3,406 |
3,134 |
$15K |
| A6539 |
Gc stocking waistlngth 18-30 |
96 |
92 |
$12K |
| A4402 |
Lubricant per ounce |
2,064 |
1,813 |
$7K |
| A6530 |
Compression stocking bk18-30 |
184 |
89 |
$6K |
| E0246 |
Transfer tub rail attachment |
118 |
112 |
$4K |
| E0561 |
Humidifier nonheated w pap |
45 |
44 |
$3K |
| E0243 |
Toilet rail |
93 |
87 |
$3K |
| E0570 |
Nebulizer with compression |
26 |
25 |
$3K |
| A4670 |
Automatic bp monitor, dial |
163 |
151 |
$2K |
| E0241 |
Bath tub wall rail |
137 |
120 |
$2K |
| E0240 |
Bath/shower chair |
55 |
55 |
$2K |
| L3217 |
Ladies shoes hightop depth i |
27 |
13 |
$2K |
| E0215 |
Electric heat pad moist |
85 |
85 |
$2K |
| L3050 |
Foot arch supp premold metat |
36 |
18 |
$1K |
| A4660 |
Sphyg/bp app w cuff and stet |
73 |
72 |
$1K |
| L3912 |
Hfo flexion glove pre ots |
32 |
29 |
$1K |
| E0274 |
Over-bed table |
12 |
12 |
$1K |
| E0190 |
Positioning cushion |
35 |
35 |
$771.40 |
| L3660 |
So 8 ab rstr can/web pre ots |
14 |
13 |
$560.00 |
| E0210 |
Electric heat pad standard |
28 |
28 |
$403.20 |
| L1902 |
Afo ankle gauntlet pre ots |
14 |
12 |
$103.58 |
| A7003 |
Nebulizer administration set |
21 |
21 |
$93.66 |