| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
17,013 |
15,373 |
$405K |
| T4527 |
Adult size pull-on lg |
7,575 |
6,977 |
$383K |
| T4526 |
Adult size pull-on med |
6,470 |
6,058 |
$278K |
| T4528 |
Adult size pull-on xl |
4,393 |
4,092 |
$271K |
| A4245 |
Alcohol wipes per box |
20,307 |
19,430 |
$162K |
| T4535 |
Disposable liner/shield/pad |
3,544 |
3,141 |
$128K |
| A4927 |
Non-sterile gloves |
17,458 |
16,701 |
$126K |
| T4524 |
Adult size brief/diaper xl |
1,943 |
1,621 |
$119K |
| T4543 |
Adult disp brief/diap abv xl |
953 |
852 |
$107K |
| E0260 |
Hosp bed semi-electr w/ matt |
145 |
130 |
$99K |
| T4544 |
Adlt disp und/pull on abv xl |
1,121 |
1,064 |
$94K |
| B4154 |
Ef spec metabolic noninherit |
261 |
227 |
$84K |
| A9276 |
Disposable sensor, cgm sys |
304 |
289 |
$82K |
| T4523 |
Adult size brief/diaper lg |
1,554 |
1,338 |
$75K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
91 |
85 |
$74K |
| T4525 |
Adult size pull-on sm |
1,507 |
1,433 |
$69K |
| A6023 |
Collagen dressing >48 sq in |
26 |
24 |
$63K |
| A4335 |
Incontinence supply |
1,826 |
1,553 |
$55K |
| B4150 |
Ef complet w/intact nutrient |
272 |
242 |
$35K |
| T4522 |
Adult size brief/diaper med |
812 |
730 |
$34K |
| S5199 |
Personal care item nos each |
1,094 |
635 |
$19K |
| K0823 |
Pwc gp 2 std cap chair |
119 |
91 |
$18K |
| K0001 |
Standard wheelchair |
796 |
722 |
$17K |
| B4035 |
Enteral feed supp pump per d |
111 |
90 |
$15K |
| A5120 |
Skin barrier, wipe or swab |
3,197 |
3,117 |
$14K |
| E0630 |
Patient lift hydraulic |
229 |
212 |
$12K |
| K0195 |
Elevating whlchair leg rests |
1,578 |
1,230 |
$10K |
| E1390 |
Oxygen concentrator |
66 |
63 |
$7K |
| E0303 |
Hosp bed hvy dty xtra wide |
37 |
36 |
$7K |
| E0143 |
Walker folding wheeled w/o s |
165 |
141 |
$7K |
| B4153 |
Ef hydrolyzed/amino acids |
13 |
12 |
$7K |
| K0003 |
Lightweight wheelchair |
470 |
308 |
$6K |
| B9002 |
Enter nutr inf pump any type |
86 |
80 |
$5K |
| K0007 |
Extra heavy duty wheelchair |
43 |
40 |
$5K |
| A4357 |
Bedside drainage bag |
274 |
273 |
$4K |
| A6248 |
Hydrogel drsg gel filler |
16 |
14 |
$3K |
| A4452 |
Waterproof tape |
81 |
70 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
229 |
216 |
$3K |
| E2611 |
Gen use back cush wdth <22in |
17 |
12 |
$3K |
| E0974 |
W/ch access anti-rollback |
78 |
50 |
$3K |
| T4537 |
Reusable underpad bed size |
316 |
258 |
$3K |
| A5512 |
Multi den insert direct form |
368 |
101 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
89 |
83 |
$2K |
| A4253 |
Blood glucose/reagent strips |
52 |
51 |
$2K |
| A6250 |
Skin seal protect moisturizr |
631 |
402 |
$2K |
| E0431 |
Portable gaseous 02 |
62 |
62 |
$2K |
| A4239 |
Non-adju cgm supply allow |
121 |
67 |
$2K |
| E0156 |
Walker seat attachment |
175 |
152 |
$1K |
| A5500 |
Diab shoe for density insert |
331 |
101 |
$1K |
| E0600 |
Suction pump portab hom modl |
25 |
25 |
$632.65 |
| A4259 |
Lancets per box |
53 |
52 |
$407.16 |
| E0978 |
W/c acc,saf belt pelv strap |
31 |
24 |
$262.26 |