| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
14,346 |
13,521 |
$839K |
| T4527 |
Adult size pull-on lg |
5,328 |
5,064 |
$541K |
| T4543 |
Adult disp brief/diap abv xl |
2,348 |
2,203 |
$487K |
| T4528 |
Adult size pull-on xl |
3,933 |
3,737 |
$444K |
| T4526 |
Adult size pull-on med |
4,535 |
4,270 |
$409K |
| T4541 |
Large disposable underpad |
9,791 |
9,036 |
$389K |
| T4537 |
Reusable underpad bed size |
3,543 |
3,425 |
$139K |
| S5161 |
Emer rspns sys serv permonth |
3,161 |
3,145 |
$104K |
| T1999 |
Noc retail items andsupplies |
297 |
273 |
$47K |
| T4525 |
Adult size pull-on sm |
542 |
519 |
$34K |
| B4150 |
Ef complet w/intact nutrient |
201 |
193 |
$25K |
| A4927 |
Non-sterile gloves |
1,307 |
1,249 |
$24K |
| K0002 |
Stnd hemi (low seat) whlchr |
403 |
403 |
$17K |
| A4335 |
Incontinence supply |
852 |
817 |
$11K |
| E1399 |
Durable medical equipment mi |
173 |
166 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
206 |
205 |
$7K |
| S5165 |
Home modifications per serv |
27 |
27 |
$3K |
| E0240 |
Bath/shower chair |
12 |
12 |
$642.51 |
| K0001 |
Standard wheelchair |
13 |
12 |
$229.16 |
| K0195 |
Elevating whlchair leg rests |
12 |
12 |
$155.08 |