| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
1,679 |
1,590 |
$168K |
| T4531 |
Ped size pull-on sm/med |
1,770 |
1,445 |
$145K |
| T4532 |
Ped size pull-on lg |
1,464 |
1,455 |
$131K |
| T4541 |
Large disposable underpad |
2,721 |
2,645 |
$118K |
| E0603 |
Electric breast pump |
1,047 |
1,045 |
$115K |
| T4522 |
Adult size brief/diaper med |
1,038 |
1,025 |
$94K |
| T4526 |
Adult size pull-on med |
845 |
800 |
$76K |
| T4535 |
Disposable liner/shield/pad |
1,331 |
1,311 |
$66K |
| T4530 |
Ped size brief/diaper lg |
737 |
642 |
$66K |
| A4253 |
Blood glucose/reagent strips |
1,609 |
1,531 |
$61K |
| A4670 |
Automatic bp monitor, dial |
1,071 |
1,057 |
$60K |
| T4527 |
Adult size pull-on lg |
552 |
532 |
$54K |
| T4534 |
Youth size pull-on |
1,302 |
1,269 |
$38K |
| T4521 |
Adult size brief/diaper sm |
353 |
333 |
$28K |
| E0570 |
Nebulizer with compression |
388 |
387 |
$22K |
| T4525 |
Adult size pull-on sm |
173 |
158 |
$15K |
| A4927 |
Non-sterile gloves |
746 |
730 |
$8K |
| A4259 |
Lancets per box |
740 |
723 |
$5K |
| A7003 |
Nebulizer administration set |
221 |
221 |
$659.97 |
| L3908 |
Who cock-up nonmolde pre ots |
15 |
13 |
$576.34 |
| A7015 |
Aerosol mask used w nebulize |
202 |
202 |
$322.96 |