| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4532 |
Ped size pull-on lg |
2,847 |
2,817 |
$459K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,088 |
1,075 |
$356K |
| A4554 |
Disposable underpads |
7,456 |
7,420 |
$259K |
| T4530 |
Ped size brief/diaper lg |
1,083 |
1,080 |
$112K |
| B9998 |
Enteral supp not otherwise c |
1,350 |
1,144 |
$105K |
| B4035 |
Enteral feed supp pump per d |
337 |
333 |
$88K |
| B4150 |
Ef complet w/intact nutrient |
291 |
287 |
$83K |
| T4523 |
Adult size brief/diaper lg |
707 |
698 |
$66K |
| T4522 |
Adult size brief/diaper med |
629 |
625 |
$60K |
| A4335 |
Incontinence supply |
10,347 |
10,280 |
$58K |
| T4525 |
Adult size pull-on sm |
455 |
454 |
$47K |
| T4526 |
Adult size pull-on med |
333 |
326 |
$37K |
| B4034 |
Enter feed supkit syr by day |
191 |
190 |
$29K |
| T4521 |
Adult size brief/diaper sm |
252 |
252 |
$24K |
| T4527 |
Adult size pull-on lg |
171 |
171 |
$21K |
| T4535 |
Disposable liner/shield/pad |
544 |
536 |
$13K |
| T4528 |
Adult size pull-on xl |
77 |
76 |
$11K |
| K0001 |
Standard wheelchair |
264 |
261 |
$11K |
| A4322 |
Irrigation syringe |
1,011 |
1,004 |
$9K |
| K0108 |
W/c component-accessory nos |
33 |
12 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
306 |
304 |
$4K |
| K0195 |
Elevating whlchair leg rests |
274 |
270 |
$4K |
| E0570 |
Nebulizer with compression |
12 |
12 |
$1K |
| 97542 |
|
34 |
30 |
$1K |
| A4213 |
20+ cc syringe only |
404 |
378 |
$1K |
| S8101 |
Spacer with mask |
26 |
26 |
$688.83 |
| A7000 |
Disposable canister for pump |
24 |
24 |
$586.97 |
| A7015 |
Aerosol mask used w nebulize |
370 |
367 |
$481.53 |
| A4450 |
Non-waterproof tape |
258 |
255 |
$421.94 |
| A7002 |
Tubing used w suction pump |
50 |
48 |
$416.59 |
| A7003 |
Nebulizer administration set |
205 |
203 |
$354.49 |
| A4628 |
Oropharyngeal suction cath |
61 |
60 |
$304.67 |
| A7005 |
Nondisposable nebulizer set |
12 |
12 |
$218.82 |
| A4927 |
Non-sterile gloves |
29 |
28 |
$197.12 |
| A6250 |
Skin seal protect moisturizr |
12 |
12 |
$60.38 |
| A7013 |
Disposable compressor filter |
13 |
12 |
$6.86 |