| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4670 |
Automatic bp monitor, dial |
2,313 |
2,213 |
$222K |
| A4554 |
Disposable underpads |
4,578 |
3,406 |
$161K |
| T4524 |
Adult size brief/diaper xl |
1,140 |
1,068 |
$128K |
| T4535 |
Disposable liner/shield/pad |
1,627 |
1,542 |
$112K |
| T4523 |
Adult size brief/diaper lg |
984 |
933 |
$101K |
| T4522 |
Adult size brief/diaper med |
755 |
700 |
$58K |
| A4927 |
Non-sterile gloves |
3,607 |
2,529 |
$27K |
| A6530 |
Compression stocking bk18-30 |
602 |
448 |
$26K |
| E0570 |
Nebulizer with compression |
68 |
67 |
$19K |
| A6402 |
Sterile gauze <= 16 sq in |
760 |
602 |
$17K |
| L3908 |
Who cock-up nonmolde pre ots |
310 |
278 |
$15K |
| A6250 |
Skin seal protect moisturizr |
732 |
493 |
$15K |
| A4245 |
Alcohol wipes per box |
1,413 |
945 |
$7K |
| E0144 |
Enclosed walker w rear seat |
33 |
25 |
$6K |
| A5120 |
Skin barrier, wipe or swab |
672 |
538 |
$3K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
69 |
40 |
$3K |
| E0245 |
Tub stool or bench |
39 |
34 |
$2K |
| A4253 |
Blood glucose/reagent strips |
2,479 |
1,903 |
$2K |
| L3030 |
Foot arch support remov prem |
26 |
25 |
$2K |
| A5500 |
Diab shoe for density insert |
13 |
13 |
$2K |
| L3216 |
Orthoped ladies shoes dpth i |
19 |
15 |
$1K |
| E0100 |
Cane adjust/fixed with tip |
68 |
67 |
$1K |
| L1830 |
Ko immob canvas long pre ots |
13 |
12 |
$929.88 |
| A4259 |
Lancets per box |
2,106 |
1,717 |
$926.44 |
| A5063 |
Drain ostomy pouch w/flange |
19 |
12 |
$864.60 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
74 |
57 |
$754.83 |
| A4217 |
Sterile water/saline, 500 ml |
127 |
99 |
$628.69 |
| A4456 |
Adhesive remover, wipes |
64 |
50 |
$397.63 |
| A6260 |
Wound cleanser any type/size |
12 |
12 |
$192.45 |
| A4452 |
Waterproof tape |
63 |
54 |
$88.33 |
| A4450 |
Non-waterproof tape |
13 |
12 |
$73.85 |
| A4520 |
Incontinence garment anytype |
3,682 |
2,303 |
$0.00 |