| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Special med equip, noswaiver |
3,701 |
3,343 |
$1.73M |
| T4527 |
Adult size pull-on lg |
1,694 |
1,544 |
$176K |
| T4541 |
Large disposable underpad |
3,540 |
3,438 |
$142K |
| T4528 |
Adult size pull-on xl |
1,127 |
1,084 |
$128K |
| T4535 |
Disposable liner/shield/pad |
1,417 |
1,361 |
$116K |
| E1399 |
Durable medical equipment mi |
458 |
404 |
$109K |
| T4526 |
Adult size pull-on med |
881 |
832 |
$83K |
| A4927 |
Non-sterile gloves |
1,588 |
1,574 |
$46K |
| E0260 |
Hosp bed semi-electr w/ matt |
631 |
622 |
$32K |
| T4534 |
Youth size pull-on |
205 |
200 |
$21K |
| K0001 |
Standard wheelchair |
531 |
526 |
$13K |
| T4544 |
Adlt disp und/pull on abv xl |
57 |
52 |
$11K |
| A5512 |
Multi den insert direct form |
144 |
72 |
$11K |
| A5500 |
Diab shoe for density insert |
144 |
72 |
$9K |
| T4543 |
Adult disp brief/diap abv xl |
26 |
24 |
$8K |
| E0570 |
Nebulizer with compression |
65 |
65 |
$2K |