| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
28,388 |
27,436 |
$1.96M |
| T4523 |
Adult size brief/diaper lg |
9,110 |
8,882 |
$1.07M |
| T4522 |
Adult size brief/diaper med |
8,688 |
8,439 |
$816K |
| T4524 |
Adult size brief/diaper xl |
5,871 |
5,661 |
$787K |
| T4537 |
Reusable underpad bed size |
20,021 |
19,302 |
$645K |
| E0603 |
Electric breast pump |
2,873 |
2,759 |
$450K |
| T4539 |
Reuse diaper/brief any size |
11,142 |
10,652 |
$346K |
| T4540 |
Reusable underpad chair size |
17,694 |
17,009 |
$308K |
| T4530 |
Ped size brief/diaper lg |
3,715 |
3,547 |
$300K |
| T4535 |
Disposable liner/shield/pad |
5,983 |
5,929 |
$222K |
| T4521 |
Adult size brief/diaper sm |
2,237 |
2,181 |
$217K |
| T4543 |
Adult disp brief/diap abv xl |
844 |
826 |
$181K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
654 |
646 |
$118K |
| A4927 |
Non-sterile gloves |
25,118 |
24,234 |
$110K |
| A4287 |
Disp col sto bag breast milk |
2,418 |
2,386 |
$100K |
| K1005 |
Disp col sto bag breast milk |
1,652 |
1,635 |
$68K |
| L2630 |
Pelvic control band & belt u |
299 |
290 |
$45K |
| E1390 |
Oxygen concentrator |
259 |
251 |
$16K |
| L0621 |
Sio flex pelvic/sacr pre ots |
208 |
207 |
$12K |
| A4335 |
Incontinence supply |
2,092 |
2,092 |
$11K |
| A4402 |
Lubricant per ounce |
1,621 |
1,618 |
$7K |
| A6250 |
Skin seal protect moisturizr |
614 |
613 |
$7K |
| A7005 |
Nondisposable nebulizer set |
204 |
203 |
$3K |
| E1399 |
Durable medical equipment mi |
215 |
215 |
$3K |
| E0144 |
Enclosed walker w rear seat |
14 |
14 |
$2K |
| A4670 |
Automatic bp monitor, dial |
37 |
37 |
$2K |
| K0001 |
Standard wheelchair |
40 |
39 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
16 |
14 |
$614.19 |
| E0240 |
Bath/shower chair |
13 |
13 |
$448.61 |
| E0156 |
Walker seat attachment |
17 |
15 |
$164.10 |