| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult size pull-on med |
2,212 |
2,076 |
$224K |
| T4535 |
Disposable liner/shield/pad |
2,158 |
2,101 |
$207K |
| T4527 |
Adult size pull-on lg |
1,464 |
1,428 |
$168K |
| T4528 |
Adult size pull-on xl |
1,597 |
1,511 |
$158K |
| A4554 |
Disposable underpads |
3,186 |
3,040 |
$118K |
| A4253 |
Blood glucose/reagent strips |
3,744 |
3,219 |
$101K |
| T4532 |
Ped size pull-on lg |
619 |
568 |
$73K |
| 0002A |
|
798 |
754 |
$36K |
| E0570 |
Nebulizer with compression |
2,112 |
1,912 |
$35K |
| 0001A |
|
849 |
786 |
$25K |
| E0260 |
Hosp bed semi-electr w/ matt |
430 |
384 |
$19K |
| A4927 |
Non-sterile gloves |
698 |
569 |
$10K |
| 0071A |
|
102 |
101 |
$9K |
| A4259 |
Lancets per box |
2,514 |
2,211 |
$9K |
| 0072A |
|
102 |
95 |
$7K |
| E0143 |
Walker folding wheeled w/o s |
171 |
142 |
$5K |
| 0003A |
|
219 |
199 |
$4K |
| K0001 |
Standard wheelchair |
299 |
269 |
$4K |
| K0823 |
Pwc gp 2 std cap chair |
85 |
74 |
$2K |
| 0004A |
|
117 |
101 |
$2K |
| G0008 |
Admin influenza virus vac |
782 |
660 |
$1K |
| E0607 |
Blood glucose monitor home |
27 |
26 |
$1K |
| 90686 |
|
318 |
233 |
$1K |
| A5500 |
Diab shoe for density insert |
13 |
13 |
$1K |
| 0012A |
|
164 |
148 |
$668.45 |
| E0114 |
Crutch underarm pair no wood |
13 |
12 |
$599.88 |
| K0003 |
Lightweight wheelchair |
54 |
54 |
$589.40 |
| 0064A |
|
88 |
81 |
$520.00 |
| 0124A |
|
65 |
61 |
$480.00 |
| 0011A |
|
191 |
164 |
$372.68 |
| E0730 |
Tens four lead |
13 |
12 |
$364.69 |
| E0156 |
Walker seat attachment |
47 |
39 |
$341.03 |
| 90656 |
|
51 |
47 |
$203.59 |
| 0013A |
|
126 |
95 |
$160.00 |
| 90674 |
|
22 |
13 |
$68.82 |
| 91300 |
|
100 |
84 |
$0.85 |
| 91301 |
|
13 |
13 |
$0.10 |
| 90662 |
|
89 |
86 |
$0.00 |
| 91320 |
|
104 |
66 |
$0.00 |
| 90756 |
|
61 |
57 |
$0.00 |
| 90653 |
|
44 |
43 |
$0.00 |
| 90694 |
|
109 |
94 |
$0.00 |
| 90480 |
|
104 |
66 |
$0.00 |