| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Special med equip, noswaiver |
5,579 |
3,379 |
$243K |
| T4528 |
Adult size pull-on xl |
2,685 |
1,849 |
$177K |
| T4527 |
Adult size pull-on lg |
2,966 |
2,030 |
$159K |
| T4541 |
Large disposable underpad |
7,124 |
5,092 |
$158K |
| T4544 |
Adlt disp und/pull on abv xl |
773 |
619 |
$114K |
| T4526 |
Adult size pull-on med |
2,267 |
1,550 |
$111K |
| B4150 |
Ef complet w/intact nutrient |
1,803 |
1,246 |
$92K |
| T4523 |
Adult size brief/diaper lg |
1,514 |
952 |
$88K |
| T4535 |
Disposable liner/shield/pad |
4,009 |
2,799 |
$72K |
| T4524 |
Adult size brief/diaper xl |
1,063 |
679 |
$64K |
| T4537 |
Reusable underpad bed size |
1,029 |
690 |
$57K |
| B4152 |
Ef calorie dense>/=1.5kcal |
833 |
512 |
$56K |
| T4522 |
Adult size brief/diaper med |
937 |
667 |
$55K |
| A4927 |
Non-sterile gloves |
5,475 |
4,071 |
$54K |
| T4525 |
Adult size pull-on sm |
1,023 |
642 |
$47K |
| T4543 |
Adult disp brief/diap abv xl |
183 |
130 |
$30K |
| T4540 |
Reusable underpad chair size |
985 |
650 |
$27K |
| E0260 |
Hosp bed semi-electr w/ matt |
379 |
306 |
$10K |
| B4154 |
Ef spec metabolic noninherit |
232 |
136 |
$9K |
| K0553 |
Ther cgm supply allowance |
93 |
67 |
$3K |
| A6530 |
Compression stocking bk18-30 |
55 |
24 |
$2K |
| A4670 |
Automatic bp monitor, dial |
40 |
28 |
$2K |
| T4536 |
Reusable pull-on any size |
22 |
14 |
$2K |
| A4253 |
Blood glucose/reagent strips |
16 |
14 |
$62.10 |
| A4259 |
Lancets per box |
14 |
12 |
$2.26 |
| G0008 |
Admin influenza virus vac |
13 |
13 |
$0.00 |