| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult size pull-on med |
31,585 |
31,098 |
$3.13M |
| T4541 |
Large disposable underpad |
14,874 |
14,571 |
$926K |
| T4535 |
Disposable liner/shield/pad |
13,152 |
12,938 |
$565K |
| T4527 |
Adult size pull-on lg |
4,646 |
4,574 |
$462K |
| T4528 |
Adult size pull-on xl |
2,056 |
2,010 |
$283K |
| E0240 |
Bath/shower chair |
1,811 |
1,748 |
$183K |
| T4543 |
Adult disp brief/diap abv xl |
350 |
337 |
$84K |
| A4927 |
Non-sterile gloves |
7,522 |
7,194 |
$69K |
| A6534 |
Gc stocking thighlngth 30-40 |
549 |
542 |
$56K |
| A6530 |
Compression stocking bk18-30 |
770 |
766 |
$32K |
| L0628 |
Lso flex no ri stays pre ots |
293 |
286 |
$27K |
| L0625 |
Lo flex l1-below l5 pre ots |
668 |
641 |
$25K |
| A4670 |
Automatic bp monitor, dial |
376 |
367 |
$22K |
| K0003 |
Lightweight wheelchair |
433 |
422 |
$12K |
| A5500 |
Diab shoe for density insert |
317 |
273 |
$10K |
| A5512 |
Multi den insert direct form |
317 |
273 |
$9K |
| E0143 |
Walker folding wheeled w/o s |
130 |
129 |
$5K |
| E0243 |
Toilet rail |
76 |
76 |
$2K |
| E0244 |
Toilet seat raised |
53 |
53 |
$1K |
| E0156 |
Walker seat attachment |
125 |
124 |
$936.93 |
| E0210 |
Electric heat pad standard |
43 |
42 |
$572.44 |