| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
985 |
956 |
$156K |
| A9276 |
Disposable sensor, cgm sys |
183 |
180 |
$46K |
| T4528 |
Adult size pull-on xl |
237 |
231 |
$42K |
| A6197 |
Alginate drsg >16 <=48 sq in |
113 |
112 |
$22K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
306 |
302 |
$22K |
| A4554 |
Disposable underpads |
529 |
507 |
$18K |
| A4452 |
Waterproof tape |
364 |
360 |
$6K |
| A6021 |
Collagen dressing <=16 sq in |
44 |
44 |
$5K |
| A6446 |
Conform band s w>=3" <5"/yd |
470 |
467 |
$4K |
| A6260 |
Wound cleanser any type/size |
154 |
153 |
$4K |
| A6536 |
Gc stocking full lngth 18-30 |
40 |
20 |
$3K |
| E0445 |
Oximeter non-invasive |
13 |
13 |
$2K |
| A6224 |
Gauze > 48 in no w/sal w/o b |
54 |
54 |
$2K |
| A4670 |
Automatic bp monitor, dial |
74 |
73 |
$2K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
341 |
335 |
$2K |
| A7005 |
Nondisposable nebulizer set |
266 |
252 |
$2K |
| A6219 |
Gauze <= 16 sq in w/border |
65 |
65 |
$1K |
| A4927 |
Non-sterile gloves |
54 |
54 |
$918.00 |
| A6212 |
Foam drg <=16 sq in w/border |
12 |
12 |
$781.44 |
| A6449 |
Lt compres band >=3" <5"/yd |
12 |
12 |
$578.61 |
| A4216 |
Sterile water/saline, 10 ml |
16 |
16 |
$146.27 |